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Wargenau M, Baase F, Eckardt K, Spitzhorn LS, Reidemeister S, Klingmann I, Klingmann V. Questionnaire Study to Investigate the Preferences of Children, Parents, and Healthcare Professionals for Different Formulations of Oral Medicinal Products. Pharmaceutics 2024; 16:515. [PMID: 38675176 PMCID: PMC11054268 DOI: 10.3390/pharmaceutics16040515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/25/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Since the acceptability of a medicine can significantly impact therapeutic outcomes, this study aimed to determine and compare the preferences of children, parents, and healthcare professionals for the most commonly used pediatric oral medicine formulations (syrup, mini-tablets, oblong tablets, round tablets) addressing all pediatric age groups, 0-<18 years (y). This survey study employed sex-, age-, and participant group-adapted questionnaires for eight cohorts of participants, i.e., children 6-<12 y, adolescents 12-<18 y, parents of children in four age groups (0-<2 y, 2-<6 y, 6-<12 y, and 12-<18 y), nurses, and pediatricians. Descriptive statistics were used for data analysis. In the age groups 0-<2 y and 2-<6 y, mini-tablets were preferred over syrup by all participants. In the age group 6-12 y, solid dosage forms were also preferred over syrup by all participants. In the age group 12-<18 y, healthcare professionals preferred solid dosage forms over syrup. Parents preferred higher amounts of mini-tablets and syrup compared to round and oblong tablets, while adolescents' preferences did not differentiate between these formulations. Based on the study results and in contrast to current practice, it is suggested to consider solid dosage forms for future age-appropriate medicinal products already for younger age groups.
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Affiliation(s)
- Manfred Wargenau
- M.A.R.C.O. GmbH & Co. KG, Institute for Clinical Research and Statistics, Schirmerstrasse 71, 40211 Duesseldorf, Germany; (M.W.); (K.E.); (L.-S.S.)
| | - Felicitas Baase
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany;
| | - Kristin Eckardt
- M.A.R.C.O. GmbH & Co. KG, Institute for Clinical Research and Statistics, Schirmerstrasse 71, 40211 Duesseldorf, Germany; (M.W.); (K.E.); (L.-S.S.)
| | - Lucas-Sebastian Spitzhorn
- M.A.R.C.O. GmbH & Co. KG, Institute for Clinical Research and Statistics, Schirmerstrasse 71, 40211 Duesseldorf, Germany; (M.W.); (K.E.); (L.-S.S.)
| | - Sibylle Reidemeister
- Novartis Pharma AG, Global Drug Development/Technical Research & Development, Novartis Campus, 4056 Basel, Switzerland;
| | - Ingrid Klingmann
- Pharmaplex bv, Avenue Saint-Hubert 51, 1970 Wezembeek-Oppem, Belgium;
| | - Viviane Klingmann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany;
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Cavelier M, Hervouët C, Varin R, Gondé H. Devices for securing and administering pediatric compounded oral liquids: survey results from French university hospitals. Eur J Pediatr 2024:10.1007/s00431-024-05547-x. [PMID: 38573361 DOI: 10.1007/s00431-024-05547-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/05/2024]
Abstract
Oral liquid forms, either commercial or compounded, are preferred in pediatrics due to their suitability for weight-based dosing and acceptability for children. The choice of dosing delivery devices associated with oral liquid forms is important to ensure accurate dosing, ease of administration, and patient safety. Given the prevalence of compounding in pediatric settings, this study aimed to investigate the practices among French university hospitals concerning the selection of dosing delivery devices associated with compounding oral liquid forms for children. An online survey was distributed to pharmacists involved in compounding in French university hospitals. The survey covered aspects such as the presence of child-resistant caps, types of dosing devices, the presence of bottle adapters, and the type of bottle adapters used. Among the 36 hospital pharmacies contacted, 24 responded to the survey. One pharmacy employed child-resistant caps for compounded liquid forms. Enteral syringes emerged as the primary dosing device (71%), with a minority using luer/luer-lock syringes (21%). Spoon and measuring cup usage was reported by none. Approximately two-thirds of the pharmacies (67%) used a bottle adapter in conjunction with the sampling device. Conclusion: The study highlighted diversity in the practices of French university hospitals regarding dosing delivery devices associated with compounding oral liquid forms for pediatric patients. The findings underscored the need for standardized guidelines to streamline practices and enhance safety and precision in compounded medication administration for children. What is Known: • Administration devices are important to ensure the correct administration of the required dose of oral liquids in pediatrics. • For compounded oral liquid forms, the selection and supply of administration devices are managed by compounding pharmacies from those available on the market. What is New: • The study highlighted the variability of administration devices associated with compounded liquids for oral use in French hospital pharmacies.
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Affiliation(s)
- Marine Cavelier
- Department of Pharmacy, CHU Rouen, Normandie University, UNIROUEN, EA7510 ESCAPE, F-76000, Rouen, France.
| | | | - Rémi Varin
- Department of Pharmacy, CHU Rouen, Normandie University, UNIROUEN, U1234, F-76000, Rouen, France
| | - Henri Gondé
- Department of Pharmacy, CHU Rouen, Normandie University, UNIROUEN, U1234, F-76000, Rouen, France
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Grim J, Armogida M, Kachroo P, Siddiqui K, Cavinato M, Araga M. Bioequivalence of a New Pediatric Paracetamol Oral Suspension Compared With a Marketed Formulation in Healthy Adults: A Randomized, Open-Label Study. Curr Ther Res Clin Exp 2024; 100:100734. [PMID: 38414712 PMCID: PMC10897852 DOI: 10.1016/j.curtheres.2024.100734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 01/25/2024] [Indexed: 02/29/2024]
Abstract
Background A new oral paracetamol formulation with the same paracetamol quantity (24 mg/mL) as a marketed formulation but with finer active ingredient particle size and lower amounts of maltitol (5.85 g/dose in the test formulation vs 7.25 g/dose in the reference formulation) and sorbitol (2.4 g/dose vs 2.83 g/dose) was developed. Objective Establish the bioequivalence of the new pediatric formulation (test treatment) compared with the marketed formulation (reference treatment). Methods This Phase I, open-label trial assigned healthy adult volunteers to a single 42-mL (1 g para-cetamol) dose of test or reference treatment. Participants received both treatments in a randomized order separated by a 72-hour washout period. The primary endpoints were AUC0-tlast (AUC vs time curve from time 0 to last measurable sampling timepoint), Cmax, and tmax. Safety assessments included adverse event, clinical laboratory, and physical examination data. Results Thirty-five participants were randomized and treated. The study population was 42.9% women (57.1% men) with a median age of 30 years; most participants were non-Hispanic White. Mean Cmax values were comparable between test and reference products, with a median tmax of 1.00 hour for both. The test/reference ratios (%) (90% CI) for AUC0-tlast and Cmax were 98.69% (96.46, 100.97) and 100.73% (95.63, 106.10), respectively. There were no adverse events or deaths. Conclusions The new paracetamol formulation is bioequivalent to the marketed formulation.
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Affiliation(s)
- Jiri Grim
- Quinta-Analytica, Praha, Czech Republic
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Kenchegowda M, Hani U, Al Fatease A, Haider N, Ramesh KVRNS, Talath S, Gangadharappa HV, Kiran Raj G, Padmanabha SH, Osmani RAM. Tiny titans- unravelling the potential of polysaccharides and proteins based dissolving microneedles in drug delivery and theranostics: A comprehensive review. Int J Biol Macromol 2023; 253:127172. [PMID: 37793514 DOI: 10.1016/j.ijbiomac.2023.127172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 10/06/2023]
Abstract
In recent years, microneedles (MNs) have emerged as a promising alternative to traditional drug delivery systems in transdermal drug delivery. The use of MNs has demonstrated significant potential in improving patient acceptance and convenience while avoiding the invasiveness of traditional injections. Dissolving, solid, hollow, coated, and hydrogel microneedles are among the various types studied for drug delivery. Dissolving microneedles (DMNs), in particular, have gained attention for their safety, painlessness, patient convenience, and high delivery efficiency. This comprehensive review primarily focuses on different types of microneedles, fabrication methods, and materials used in fabrication of DMNs such as hyaluronic acid, chitosan, alginate, gelatin, collagen, silk fibroin, albumin, cellulose and starch, to list a few. The review also provides an exhaustive discussion on the applications of DMNs, including the delivery of vaccines, cosmetic agents, contraceptives, hormone and genes, and other therapeutic applications like for treating cancer, skin diseases, and diabetes, among others, are covered in this review. Additionally, this review highlights some of the DMN systems that are presently undergoing clinical trials. Finally, the review discusses current advances and trends in DMNs, as well as future prospective directions for this ground-breaking technology in drug delivery.
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Affiliation(s)
- Madhuchandra Kenchegowda
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education & Research (JSS AHER), Mysuru 570015, Karnataka, India
| | - Umme Hani
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia
| | - Adel Al Fatease
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia
| | - Nazima Haider
- Department of Pathology, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - K V R N S Ramesh
- Department of Pharmaceutics, RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah 11172, United Arab Emirates
| | - Sirajunisa Talath
- Department of Pharmaceutical Chemistry, RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah 11172, United Arab Emirates
| | - Hosahalli V Gangadharappa
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education & Research (JSS AHER), Mysuru 570015, Karnataka, India.
| | - G Kiran Raj
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education & Research (JSS AHER), Mysuru 570015, Karnataka, India
| | - Sharath Honganoor Padmanabha
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education & Research (JSS AHER), Mysuru 570015, Karnataka, India
| | - Riyaz Ali M Osmani
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education & Research (JSS AHER), Mysuru 570015, Karnataka, India.
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Clapham D, Belissa E, Inghelbrecht S, Pensé-Lhéritier AM, Ruiz F, Sheehan L, Shine M, Vallet T, Walsh J, Tuleu C. A Guide to Best Practice in Sensory Analysis of Pharmaceutical Formulations. Pharmaceutics 2023; 15:2319. [PMID: 37765288 PMCID: PMC10535428 DOI: 10.3390/pharmaceutics15092319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/25/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
It is well established that treatment regime compliance is linked to the acceptability of a pharmaceutical formulation, and hence also to therapeutic outcomes. To that end, acceptability must be assessed during the development of all pharmaceutical products and especially for those intended for paediatric patients. Although acceptability is a multifaceted concept, poor sensory characteristics often contribute to poor patient acceptability. In particular, poor taste is often cited as a major reason for many patients, especially children, to refuse to take their medicine. It is thus important to understand and, as far as possible, optimise the sensory characteristics and, in particular, the taste/flavour/mouthfeel of the formulation throughout the development of the product. Sensory analysis has been widely practiced, providing objective data concerning the sensory aspects of food and cosmetic products. In this paper, we present proposals concerning how the well-established principles of sensory analysis can best be applied to pharmaceutical product development, allowing objective, scientifically valid, sensory data to be obtained safely. We briefly discuss methodologies that may be helpful in reducing the number of samples that may need to be assessed by human volunteers. However, it is only possible to be sure whether or not the sensory characteristics of a pharmaceutical product are non-aversive to potential users by undertaking sensory assessments in human volunteers. Testing is also required during formulation assessment and to ensure that the sensory characteristics remain acceptable throughout the product shelf life. We provide a risk assessment procedure to aid developers to define where studies are low risk, the results of a survey of European regulators on their views concerning such studies, and detailed guidance concerning the types of sensory studies that can be undertaken at each phase of product development, along with guidance about the practicalities of performing such sensory studies. We hope that this guidance will also lead to the development of internationally agreed standards between industry and regulators concerning how these aspects should be measured and assessed throughout the development process and when writing and evaluating regulatory submissions. Finally, we hope that the guidance herein will help formulators as they seek to develop better medicines for all patients and, in particular, paediatric patients.
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Affiliation(s)
- David Clapham
- Independent Researcher, Bishop’s Stortford CM23 4FQ, UK
| | | | | | | | - Fabrice Ruiz
- ClinSearch, 92240 Malakoff, France; (F.R.); (T.V.)
| | - Liz Sheehan
- SRL Pharma, T12 XF62 Cork, Ireland; (L.S.); (M.S.)
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Hummler H, Sarwinska D, Weitschies W, Gollasch M, Page S. Parameters to Consider for Successful Medication Use in Older Adults - an AGePOP Review. Eur J Pharm Sci 2023:106453. [PMID: 37149104 DOI: 10.1016/j.ejps.2023.106453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/27/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
Older adults are the main users of medicine and due to their multimorbidity are often faced/confronted with a complex medication management. This review article provides a brief overview on aspects of medication management such as maintaining a stock of the required medicine, understanding and following the instructions for use, coping with the primary and secondary packaging as well as preparation prior to use. The main focus however is on the drug intake itself and provides an overview about the current understanding of real life dosing conditions of older adults and geriatric patients. Furthermore, it elaborates the acceptability of dosage forms, in particular solid oral dosage forms as they represent the majority of dosage forms taken by these patient populations. An improved understanding of the needs of older adults and geriatric patients, their acceptability of various dosage forms and the circumstances under which they manage their medications, will make the design of more patient-centric drug products possible.
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Affiliation(s)
- Henriette Hummler
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacher Str. 124, CH-4070, Basel, Switzerland
| | - Dorota Sarwinska
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17489, Greifswald, Germany
| | - Werner Weitschies
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17489, Greifswald, Germany
| | - Maik Gollasch
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Susanne Page
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacher Str. 124, CH-4070, Basel, Switzerland.
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Hummler H, Page S, Stillhart C, Meilicke L, Grimm M, Mannaa M, Gollasch M, Weitschies W. Influence of Solid Oral Dosage Form Characteristics on Swallowability, Visual Perception, and Handling in Older Adults. Pharmaceutics 2023; 15:pharmaceutics15041315. [PMID: 37111799 PMCID: PMC10142368 DOI: 10.3390/pharmaceutics15041315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Swallowability, visual perception, and any handling to be conducted prior to use are all influence factors on the acceptability of an oral dosage form by the patient. Knowing the dosage form preferences of older adults, as the major group of medication end users, is needed for patient-centric drug development. This study aimed at evaluating the ability of older adults to handle tablets as well as to assess the anticipated swallowability of tablets, capsules, and mini tablets based on visual perception. The randomized intervention study included 52 older adults (65 to 94 years) and 52 younger adults (19 to 36 years). Within the tested tablets, ranging from 125 mg up to 1000 mg in weight and being of different shapes, handling was not seen as the limiting factor for the decision on appropriate tablet size. However, the smallest sized tablets were rated worst. According to visual perception, the limit of acceptable tablet size was reached at around 250 mg for older adults. For younger adults, this limit was shifted to higher weights and was dependent on the tablet shape. Differences in anticipated swallowability with respect to tablet shapes were most pronounced for tablets of 500 mg and 750 mg in weight, independent of the age category. Capsules performed worse compared to tablets, while mini tablets appeared as a possible alternative dosage form to tablets of higher weight. Within the deglutition part of this study, swallowability capabilities of the same populations were assessed and have been reported previously. Comparing the present results with the swallowing capabilities of the same populations with respect to tablets, it shows adults' clear self-underestimation of their ability to swallow tablets independent of their age.
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Affiliation(s)
- Henriette Hummler
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacher Str. 124, CH-4070 Basel, Switzerland
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Susanne Page
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacher Str. 124, CH-4070 Basel, Switzerland
| | - Cordula Stillhart
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacher Str. 124, CH-4070 Basel, Switzerland
| | - Lisa Meilicke
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Michael Grimm
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Marwan Mannaa
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17489 Greifswald, Germany
| | - Maik Gollasch
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17489 Greifswald, Germany
| | - Werner Weitschies
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17489 Greifswald, Germany
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Hummler H, Stillhart C, Meilicke L, Grimm M, Krause E, Mannaa M, Gollasch M, Weitschies W, Page S. Impact of Tablet Size and Shape on the Swallowability in Older Adults. Pharmaceutics 2023; 15:pharmaceutics15041042. [PMID: 37111528 PMCID: PMC10145850 DOI: 10.3390/pharmaceutics15041042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Older adults represent the major target population for oral medications, due to the high prevalence of multimorbidity. To allow for successful pharmacological treatments, patients need to adhere to their medication and, thus, patient-centric drug products with a high level of acceptability by the end users are needed. However, knowledge on the appropriate size and shape of solid oral dosage forms, as the most commonly used dosage forms in older adults, is still scarce. A randomized intervention study was performed including 52 older adults (65 to 94 years) and 52 young adults (19 to 36 years). Each participant swallowed four coated placebo tablets differing in weight (250 to 1000 mg) and shape (oval, round, oblong) in a blinded manner on three study days. The choice of tablet dimensions allowed for a systematic comparison between different tablet sizes of the same shape, as well as between different tablet shapes. Swallowability was assessed using a questionnaire-based method. All tested tablets were swallowed by ≥80% of adults, independent of age. However, only the 250 mg oval tablet was classified as well swallowable by ≥80% of old participants. The same was true for young participants; however, they also considered the 250 mg round and the 500 mg oval tablet as well swallowable. Furthermore, swallowability was seen to influence the willingness to take a tablet on a daily basis, especially for an intake over longer time periods.
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Affiliation(s)
- Henriette Hummler
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacherstr. 124, CH-4070 Basel, Switzerland
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Cordula Stillhart
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacherstr. 124, CH-4070 Basel, Switzerland
| | - Lisa Meilicke
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Michael Grimm
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Elischa Krause
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Ellernholzstr. 1/2, 17489 Greifswald, Germany
| | - Marwan Mannaa
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., 17489 Greifswald, Germany
| | - Maik Gollasch
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., 17489 Greifswald, Germany
| | - Werner Weitschies
- Center of Drug Absorption and Transport, Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Susanne Page
- Pharma Technical Development, F. Hoffmann-La Roche Ltd., Grenzacherstr. 124, CH-4070 Basel, Switzerland
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Pokharkar V, Sajith M, Vallet T, Akshantal S, Shah R, Ruiz F, Salunke S. Acceptability of different oral dosage forms in paediatric patients in hospital setting. Arch Dis Child 2022; 107:796-801. [PMID: 34799375 DOI: 10.1136/archdischild-2021-322604] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/31/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The understanding of acceptability of existing dosage forms is limited in most of the world and hinders the development of acceptable, age-appropriate medicines. The attributes of paediatric medicine acceptability may differ from country to country based on culture, healthcare infrastructure and health policies. This study was designed to map the acceptability of oral medicines in paediatric patients treated in hospital in India. METHODS An observational, cross-sectional study was conducted in patients aged below 18 years and taking any form of oral medication. Acceptability scores were obtained using CAST-ClinSearch Acceptability Score Test tool. FINDINGS 490 patients were recruited and 193 evaluations of different pharmaceutical products available in 20 dosage forms and 7 routes of administration were studied. Oral liquids (50%) and tablets (35%) were the most commonly prescribed and administered forms. Regardless of the therapeutic class and age, the oral liquids were 'positively accepted' in infants and toddlers. Acceptability of tablets improved with age and appeared to be generally good from the age of 6. CONCLUSION This study indicates the limited progress towards adoption of age-appropriate dosage forms in India and thus impact on the acceptability of existing oral dosage forms. The key challenges posed by the adoption of age-appropriate formulations in India are (1) awareness of importance of appropriate administration and acceptability of medicines to children in India, (2) availability of age-appropriate dosage forms and (3) lack of child-appropriate medicine policies.
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Affiliation(s)
- Varsha Pokharkar
- Department of Pharmaceutics, Bharati Vidyapeeth Deemed University Poona College of Pharmacy, Pune, India
| | - Manjusha Sajith
- Department of Pharmaceutics, Bharati Vidyapeeth Deemed University Poona College of Pharmacy, Pune, India
| | | | - Shruti Akshantal
- Department of Pharmaceutics, Bharati Vidyapeeth Deemed University Poona College of Pharmacy, Pune, India
| | - Rathin Shah
- Department of Pharmaceutics, Bharati Vidyapeeth Deemed University Poona College of Pharmacy, Pune, India
| | | | - Smita Salunke
- School of Pharmacy, University College London, London, UK
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Evers M, Weis D, Antonyuk S, Thommes M. Particle movement in the spheronizer – Experimental investigations with respect to the toroidal and poloidal direction. POWDER TECHNOL 2022; 404:117452. [DOI: 10.1016/j.powtec.2022.117452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Klingmann V, Vallet T, Münch J, Stegemann R, Wolters L, Bosse HM, Ruiz F. Dosage Forms Suitability in Pediatrics: Acceptability of Analgesics and Antipyretics in a German Hospital. Pharmaceutics 2022; 14:pharmaceutics14020337. [PMID: 35214070 PMCID: PMC8879646 DOI: 10.3390/pharmaceutics14020337] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 01/27/2023] Open
Abstract
Although medicine acceptability is likely to have a significant impact on the patient’s adherence in pediatrics and therefore on therapy success, there is still little data even for common therapeutic areas. For analgesics/antipyretics, healthcare professionals face a wide variety of products and need knowledge to select the best adapted product for each patient. We investigated acceptability of those products most used at the University Children’s Hospital Düsseldorf, Germany. Based on 180 real-life observer reports of medicine intake, we used the acceptability reference framework to score acceptability of six distinct medicines. Both ibuprofen and paracetamol tablets, mainly used in adolescents, were positively accepted. This was not the case for the solution for injection of metamizole sodium. Regarding syrups, mainly used in children under 6 years of age, ibuprofen flavored with strawberry and provided with an oral syringe was positively accepted, while paracetamol flavored with orange and provided with a measuring cup was not. Suppository appeared to be an alternative to oral liquids in infants and toddlers with palatability and administration issues. Differences appeared to be driven by dosage forms and formulations. These findings improve knowledge on acceptability drivers and might help formulating and prescribing better medicines for children.
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Affiliation(s)
- Viviane Klingmann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (R.S.); (L.W.); (H.-M.B.)
- Correspondence: (V.K.); (F.R.); Tel.: +49-211-81-17687 (V.K.); +33-1-4735-1717 (F.R.)
| | - Thibault Vallet
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France;
| | - Juliane Münch
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (R.S.); (L.W.); (H.-M.B.)
| | - Robin Stegemann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (R.S.); (L.W.); (H.-M.B.)
| | - Lena Wolters
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (R.S.); (L.W.); (H.-M.B.)
| | - Hans-Martin Bosse
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (R.S.); (L.W.); (H.-M.B.)
| | - Fabrice Ruiz
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France;
- Correspondence: (V.K.); (F.R.); Tel.: +49-211-81-17687 (V.K.); +33-1-4735-1717 (F.R.)
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12
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Perez F, Vallet T, Bravo Z, Callahan K, Ruiz F. Acceptability of Mebendazole Chewable Tablet in Children Aged 2 to 4 Years in Peru. Pharmaceutics 2021; 14:pharmaceutics14010027. [PMID: 35056923 PMCID: PMC8780656 DOI: 10.3390/pharmaceutics14010027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 01/13/2023] Open
Abstract
Soil-transmitted helminthiasis (STH) is among the most common of parasitic infections, affecting vulnerable populations in tropical/subtropical areas globally. In endemic countries, children, a high-risk population, require treatment and preventive interventions. Mebendazole, a WHO-recommended medicine, originally formulated as a tablet that was often crushed for administration to young children unable to swallow it, was reformulated as a chewable tablet. Acceptability is a key aspect for treatment effectiveness in pediatrics. Herein, we used a validated data-driven approach to investigate the acceptability of the 500-mg mebendazole chewable tablet in children aged 2 to 4 years in Peru. Observer-reported outcomes were collected for 182 medicine intakes. Acceptability was scored using the acceptability reference framework: a three-dimensional map juxtaposing “positively accepted” and “negatively accepted” profiles. Results found that the 500-mg mebendazole chewable tablet was classified as “positively accepted” in children aged 2 to 4 years. Acceptability increased with age and some acceptability issue remain for the younger children. Nevertheless, this formulation was considerably better accepted than the conventional tablets regardless of treatment in young children. This chewable formulation appears to be an appropriate alternative to the hard tablet of mebendazole for treatment of STH and preventive interventions in children aged 2 to 4 years.
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Affiliation(s)
- Fernando Perez
- INMED Partnerships for Children/INMED Andes, 21630 Ridgetop Circle, Sterling, VA 20166, USA; (F.P.); (Z.B.); (K.C.)
| | - Thibault Vallet
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France;
| | - Zarela Bravo
- INMED Partnerships for Children/INMED Andes, 21630 Ridgetop Circle, Sterling, VA 20166, USA; (F.P.); (Z.B.); (K.C.)
| | - Kristin Callahan
- INMED Partnerships for Children/INMED Andes, 21630 Ridgetop Circle, Sterling, VA 20166, USA; (F.P.); (Z.B.); (K.C.)
| | - Fabrice Ruiz
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France;
- Correspondence: ; Tel.: +33-1-4735-1717
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Vallet T, Bensouda Y, Saito J, Mathiesen L, Pokharkar V, Klingmann V, Peak M, Elhamdaoui O, Yamatani A, Ivanovic I, Sajith M, Münch J, Bracken L, Duncan JC, Salunke S, Wang S, Ruiz F. Exploring Acceptability Drivers of Oral Antibiotics in Children: Findings from an International Observational Study. Pharmaceutics 2021; 13:1721. [PMID: 34684014 PMCID: PMC8537532 DOI: 10.3390/pharmaceutics13101721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
Antibiotics are among the most commonly prescribed drugs in children. Adherence to the treatment with these drugs is of the utmost importance to prevent the emergence of resistant bacteria, a global health threat. In children, medicine acceptability is likely to have a significant impact on compliance. Herein we used a multivariate approach, considering simultaneously the many aspects of acceptability to explore the drivers of oral antibiotic acceptability in children under twelve, especially in toddlers and in preschoolers. Based on 628 real-life observer reports of the intake of 133 distinct medicines, the acceptability reference framework highlighted the influence of many factors such as age and sex of patients, previous exposure to treatment, place of administration, administration device, flavor agent in excipients and active pharmaceutical ingredient. These findings from an international observational study emphasize the multidimensional nature of acceptability. Therefore, it is crucial to consider all these different aspects for assessing this multi-faceted concept and designing or prescribing a medicine in order to reach adequate acceptability in the target population.
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Affiliation(s)
| | - Yahya Bensouda
- Faculty of Pharmacy and Medicine, Mohammed V University in Rabat, Rabat 10170, Morocco; (Y.B.); (O.E.)
- Specialties Hospital, University Medical Centre Ibn Sina (CHIS), Rabat 10170, Morocco
| | - Jumpei Saito
- National Center for Child Health and Development, Tokyo 157-8535, Japan; (J.S.); (A.Y.)
| | - Liv Mathiesen
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, 0316 Oslo, Norway; (L.M.); (I.I.)
| | - Varsha Pokharkar
- Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune 411038, India; (V.P.); (M.S.)
| | - Viviane Klingmann
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany; (V.K.); (J.M.)
| | - Matthew Peak
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK; (M.P.); (L.B.); (J.C.D.)
| | - Omar Elhamdaoui
- Faculty of Pharmacy and Medicine, Mohammed V University in Rabat, Rabat 10170, Morocco; (Y.B.); (O.E.)
- Specialties Hospital, University Medical Centre Ibn Sina (CHIS), Rabat 10170, Morocco
| | - Akimasa Yamatani
- National Center for Child Health and Development, Tokyo 157-8535, Japan; (J.S.); (A.Y.)
| | - Ivana Ivanovic
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, 0316 Oslo, Norway; (L.M.); (I.I.)
| | - Manjusha Sajith
- Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune 411038, India; (V.P.); (M.S.)
| | - Juliane Münch
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany; (V.K.); (J.M.)
| | - Louise Bracken
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK; (M.P.); (L.B.); (J.C.D.)
| | - Jennifer Claire Duncan
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK; (M.P.); (L.B.); (J.C.D.)
| | - Smita Salunke
- Department of Pharmaceutics, University College London School of Pharmacy, London WC1N 1AX, UK;
| | - Siri Wang
- Norwegian Medicines Agency, 0213 Oslo, Norway;
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Vallet T, Michelon H, Orlu M, Jani Y, Leglise P, Laribe-Caget S, Piccoli M, Le Fur A, Liu F, Ruiz F, Boudy V. Acceptability in the Older Population: The Importance of an Appropriate Tablet Size. Pharmaceutics 2020; 12:E746. [PMID: 32784378 DOI: 10.3390/pharmaceutics12080746] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/22/2020] [Accepted: 08/05/2020] [Indexed: 12/14/2022] Open
Abstract
Presenting many advantages, solid oral dosage forms (SODFs) are widely manufactured and frequently prescribed in older populations regardless of the specific characteristics of patients. Commonly, patients with dysphagia (swallowing disorders) experience difficulties taking SODFs, which may lead to non-adherence or misuse. SODF characteristics (e.g., size, shape, thickness) are likely to influence swallowability. Herein, we used the acceptability reference framework (the ClinSearch acceptability score test (CAST))—a 3D-map juxtaposing two acceptability profiles—to investigate the impact of tablet size on acceptability. We collected 938 observer reports on the tablet intake by patients ≥65 years in hospitals or care homes. As we might expect, tablets could be classified as accepted in older patients without dysphagia (n = 790), while not in those with swallowing disorders (n = 146). However, reducing the tablet size had a significant impact on acceptability in this subpopulation: tablets <6.5 mm appeared to be accepted by patients with swallowing disorders. Among the 309 distinct tablets assessed in this study, ranging in size from 4.7 to 21.5 mm, 83% are ≥6.5 mm and consequently may be poorly accepted by institutionalized older people and older inpatients suffering from dysphagia. This underlines the need to develop and prescribe medicines with the best adapted characteristics to reach an optimal acceptability in targeted users.
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Guillot AJ, Cordeiro AS, Donnelly RF, Montesinos MC, Garrigues TM, Melero A. Microneedle-Based Delivery: An Overview of Current Applications and Trends. Pharmaceutics 2020; 12:pharmaceutics12060569. [PMID: 32575392 PMCID: PMC7355570 DOI: 10.3390/pharmaceutics12060569] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 12/18/2022] Open
Abstract
Microneedle arrays (MNA) are considered as one of the most promising resources to achieve systemic effects by transdermal delivery of drugs. They are designed as a minimally invasive, painless system which can bypass the stratum corneum, overcoming the potential drawbacks of subcutaneous injections and other transdermal delivery systems such as chemical enhancers, nano and microparticles, or physical treatments. As a trendy field in pharmaceutical and biomedical research, its applications are constantly evolving, even though they are based on very well-established techniques. The number of molecules administered by MNA are also increasing, with insulin and vaccines administration being the most investigated. Furthermore, MNA are being used to deliver cells and applied in other organs and tissues like the eyes and buccal mucosae. This review intends to offer a general overview of the current state of MNA research, focusing on the strategies, applications, and types of molecules delivered recently by these systems. In addition, some information about the materials and manufacturing processes is presented and safety data is discussed.
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Affiliation(s)
- Antonio José Guillot
- Department of Pharmacy and Pharmaceutical Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Avda. Vincent Andrés Estellés s/n, 46100 Burjassot, Spain; (A.J.G.); (A.M.)
| | - Ana Sara Cordeiro
- School of Pharmacy, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK; (A.S.C.); (R.F.D.)
| | - Ryan F. Donnelly
- School of Pharmacy, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK; (A.S.C.); (R.F.D.)
| | - M. Carmen Montesinos
- Department of Pharmacology, Faculty of Pharmacy, University of Valencia, Avda. Vincent Andrés Estellés s/n, 46100 Burjassot, Spain
- Center of Molecular Recognition and Technological Development (IDM), 46100 Burjassot, Spain
- Correspondence: (M.C.M.); (T.M.G.)
| | - Teresa M. Garrigues
- Department of Pharmacy and Pharmaceutical Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Avda. Vincent Andrés Estellés s/n, 46100 Burjassot, Spain; (A.J.G.); (A.M.)
- Correspondence: (M.C.M.); (T.M.G.)
| | - Ana Melero
- Department of Pharmacy and Pharmaceutical Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Avda. Vincent Andrés Estellés s/n, 46100 Burjassot, Spain; (A.J.G.); (A.M.)
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