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Wan XH, Shu QX, Wang ZQ, Yang DY, Yang M, Wang XC, Wu ZF. [Critical influencing factors on quality of traditional Chinese medicine preparations from perspective of process and equipment]. Zhongguo Zhong Yao Za Zhi 2024; 49:1699-1704. [PMID: 38621954 DOI: 10.19540/j.cnki.cjcmm.20231128.301] [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] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
The quality of traditional Chinese medicine preparations is directly related to the safety of patients. Among the various factors, the process and corresponding critical equipment are critical factors influencing the quality of the preparations. To improve the quality of traditional Chinese medicine preparations, this article summarizes and analyzes the problems in the process links and corresponding critical equipment in the manufacturing process of traditional Chinese medicine preparations. Furthermore, a critical quality attribute evaluation system is established based on safety and effectiveness combined with the drug properties, preparation process, and preparation characteristics, providing a basis for the process and equipment improvements aimed at quality enhancement.
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Affiliation(s)
- Xin-Hao Wan
- Key Laboratory of Modern Preparation of TCM, Ministry of Education, Jiangxi University of Chinese Medicine Nanchang 330004, China
| | - Qing-Xia Shu
- Jiangxi Institute for Drug Control Nanchang 330004, China
| | - Zi-Qian Wang
- Key Laboratory of Modern Preparation of TCM, Ministry of Education, Jiangxi University of Chinese Medicine Nanchang 330004, China Jiangxi Drug Inspection Center Nanchang 330004, China
| | - Dong-Yin Yang
- Key Laboratory of Modern Preparation of TCM, Ministry of Education, Jiangxi University of Chinese Medicine Nanchang 330004, China
| | - Ming Yang
- Key Laboratory of Modern Preparation of TCM, Ministry of Education, Jiangxi University of Chinese Medicine Nanchang 330004, China
| | - Xue-Cheng Wang
- Key Laboratory of Modern Preparation of TCM, Ministry of Education, Jiangxi University of Chinese Medicine Nanchang 330004, China
| | - Zhen-Feng Wu
- Key Laboratory of Modern Preparation of TCM, Ministry of Education, Jiangxi University of Chinese Medicine Nanchang 330004, China
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White LR, White CM. Eye Drop Quality Issues: Can the FDA See This One Through? Ann Pharmacother 2024:10600280241233255. [PMID: 38380630 DOI: 10.1177/10600280241233255] [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] [Indexed: 02/22/2024] Open
Abstract
The Food and Drug Administration (FDA) has long suffered from a lack of resources limiting their inspection capacity. They have fallen behind on proactive surveillance inspections of foreign manufacturing sites, relying instead on for-cause inspections after a problem has been discovered. Over-the-counter (OTC) products are especially vulnerable because the FDA considers them lower priority. This issue recently made big news after improperly manufactured OTC eye drops harmed users across the country, in some cases causing blindness. To prevent future harm to Americans, it is imperative that the FDA receives enough resources to keep up with their routine inspections.
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Affiliation(s)
- Lyla R White
- School of Pharmacy, University of Connecticut, Storrs, CT, USA
| | - C Michael White
- School of Pharmacy, University of Connecticut, Storrs, CT, USA
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Mukherjee A, Surial R, Sahay S, Thakral Y, Gondara A. Social and cultural determinants of antibiotics prescriptions: analysis from a public community health centre in North India. Front Pharmacol 2024; 15:1277628. [PMID: 38333004 PMCID: PMC10850286 DOI: 10.3389/fphar.2024.1277628] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
This paper explores the socio cultural and institutional determinants of irresponsible prescription and use of antibiotics which has implications for the rise and spread of antimicrobial resistance (AMR). This study describes the patterns of prescription of antibiotics in a public facility in India and identifies the underlying institutional, cultural and social determinants driving the irresponsible use of antibiotics. The analysis is based on an empirical investigation of patients' prescriptions that reach the in-house pharmacy following an outpatient department (OPD) encounter with the clinician. The prescription analysis describes the factors associated with use of broad-spectrum antibiotics, and a high percentage of prescriptions for dental outpatient department prescribed as a precautionary measure. This paper further highlights the need for future research insights in combining socio-cultural approach with medical rationalities, to further explore questions our analysis highlights like higher antibiotic prescription, etc., Along with the recommendations for further research.
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Affiliation(s)
- Arunima Mukherjee
- Department of Informatics, University of Oslo, Oslo, Norway
- Society of Health Information Systems Programmes, New Delhi, India
| | - Rashmi Surial
- Society of Health Information Systems Programmes, New Delhi, India
| | - Sundeep Sahay
- Department of Informatics, University of Oslo, Oslo, Norway
- Society of Health Information Systems Programmes, New Delhi, India
- Centre for Sustainable Healthcare Education (SHE), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Yogita Thakral
- Department of Informatics, University of Oslo, Oslo, Norway
- Society of Health Information Systems Programmes, New Delhi, India
| | - Amandeep Gondara
- Society of Health Information Systems Programmes, New Delhi, India
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Mukhtar MD, Rufa’i FA, Yola AU, Babba NI, Baecker D. Evaluating the Potency of Selected Antibiotic Medications Dispensed in Community Pharmacies in Gwale, Kano, Nigeria. Antibiotics (Basel) 2023; 12:1582. [PMID: 37998784 PMCID: PMC10668698 DOI: 10.3390/antibiotics12111582] [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: 09/22/2023] [Revised: 10/21/2023] [Accepted: 10/29/2023] [Indexed: 11/25/2023] Open
Abstract
The worsening of antibiotic resistance is a multifactorial process. One aspect of this is the counterfeiting of antibiotic medications. This is supposed to be particularly high in developing countries, including Nigeria. Therefore, the potency of some antibiotic drugs dispensed in community pharmacies in Gwale, Kano, Nigeria, was investigated in this case study. Three products, each from different manufacturers, with the active ingredients of ceftriaxone, gentamicin, ciprofloxacin, and metronidazole, respectively, were included in this study. By means of a disc-diffusion assay, the effect against the typed strains Staphylococcus aureus (ATCC 25923) and Escherichia coli (ATCC 25922) as well as Clostridium tetani isolated from soil was tested. Clinical isolates of S. aureus and E. coli were also used. While antibiotics, with the exception of ciprofloxacin-containing preparations against C. tetani, showed acceptable efficacy against the typed strains by comparison with the clinical science laboratory references, a predominant failure was observed with the clinical isolates. Thus, the investigated drug preparations can be considered of acceptable quality for the treatment of susceptible bacterial infections. This excludes counterfeits in the sampled preparations. However, the insufficient efficacy against clinical isolates further documents the severity of nosocomial bacteria.
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Affiliation(s)
- Muhammad Dauda Mukhtar
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Bayero University Kano, Gwarzo Road, Kano PMB 3011, Nigeria; (A.U.Y.); (N.I.B.)
| | - Fatihu Ahmad Rufa’i
- Kano Liaison Office, Nigerian Institute for Trypanosomiasis (and Onchocerciasis) Research, Surame Road, Kaduna PMB 2077, Nigeria;
| | - Abdurrahaman Umar Yola
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Bayero University Kano, Gwarzo Road, Kano PMB 3011, Nigeria; (A.U.Y.); (N.I.B.)
| | - Nafisa Ibrahim Babba
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Bayero University Kano, Gwarzo Road, Kano PMB 3011, Nigeria; (A.U.Y.); (N.I.B.)
| | - Daniel Baecker
- Department of Pharmaceutical and Medicinal Chemistry, Institute of Pharmacy, Freie Universität Berlin, Königin-Luise-Straße 2+4, 14195 Berlin, Germany
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Li S, Sun L. Analysis of the problems of drug sampling and testing programme under tripartite system reform in China. J Eval Clin Pract 2023; 29:181-190. [PMID: 35719019 DOI: 10.1111/jep.13725] [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: 01/26/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 01/18/2023]
Abstract
RATIONALE To ensure that quality medicines are available to the populace. AIM AND OBJECTIVE To provide a new perspective for drug sampling and testing using a risk-based approach globally, and provide a reference for improving the efficiency of the drug sampling and testing programme in China. METHOD This study used a combination of theoretical analysis and problem analysis. First, we analysed the high-risk drugs that should be given attention to theoretically in the drug sampling testing programme based on the healthcare reform in China. Second, this study leveraged on data on the sampling and testing of drugs extracted from self-constructed data by the China Food and Drug Administration (CFDA). The integrated and structured data sets were used to conduct an innovative analysis that identifies the actual content of the drug sampling and testing programme and contrasts them with the theoretical content to understand the problems. This study used quantitative and qualitative approaches for data analysis. RESULTS Following analysis, we discovered that there is still a big gap between the reality of drug sampling and testing in China and the ideal state of the objective requirements of healthcare reforms. The major sources of risk are the retail pharmacies or hospital pharmacies in the distribution chain of drugs; however, the CFDA sampled mostly drugs from drug manufacturers. Additionally, the CFDA did not sample adequate essential medicines, bid-winning drugs (especially those with large price drops in centralized procurement), biological products and other high-risk drug varieties. The high-risk drugs produced by companies or enterprises with a history of noncompliance, especially bid-winning enterprises in centralized procurement, were not sampled. CONCLUSION We suggest that the major content of drug sampling and testing in China should focus on the link of drug utilization, varieties of drugs with large price drops in centralized procurement and bid-winning enterprises with a history of noncompliance.
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Affiliation(s)
- Shiqi Li
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, Liaoning Province, China
| | - Lihua Sun
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, Liaoning Province, China
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Gumułka P, Tarsa M, Dąbrowska M, Starek M. Quantification of Grapiprant and Its Stability Testing under Changing Environmental Conditions. Biomedicines 2022; 10:2821. [PMID: 36359341 PMCID: PMC9687689 DOI: 10.3390/biomedicines10112821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/06/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 04/11/2024] Open
Abstract
Grapiprant is a new analgesic and anti-inflammatory drug belonging to the piprant class, approved in 2016 by the FDA Veterinary Medicine Center for the treatment of pain and inflammation associated with osteoarthritis in dogs. It acts as a highly selective antagonist of the EP4 receptor, one of the four prostaglandin E2 (PGE2) receptor subtypes. It has been shown to have anti-inflammatory effects in rat models of acute and chronic inflammation and clinical studies in people with osteoarthritis. The current state of knowledge suggests the possibility of using it in oncological therapy. The manuscript presents the development of conditions for the identification and quantitative determination of grapiprant by thin-layer chromatography with densitometric detection. The optimal separation of the substance occurs using silica gel 60F254 chromatographic plates and the mobile phase containing ethyl acetate-toluene-butylamine. Validation (according to ICH requirements) showed that the developed method is characterized by straightness of results in a wide concentration range with the limit of detection of 146.65 µg/mL. The %RSD values of the precision and accuracy confirm the sensitivity and reliability of the developed procedure. Next, the method was used for quantification of grapiprant in a pharmaceutical preparation, and for stability studies under various environmental conditions. Additionally, the mass studies were carried out on the stressed samples using the UPLC-MS/MS method. The degradation products were primarily characterized by comparing their mass fragmentation profiles with those of the drug. The results indicated a potential degradation pathway for grapiprant.
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Affiliation(s)
- Paweł Gumułka
- Department of Inorganic and Analytical Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Kraków, Poland
- Doctorial School of Medical and Health Sciences, Jagiellonian University Medical College, 16 Łazarza St., 31-530 Kraków, Poland
| | - Monika Tarsa
- Department of Organic Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Kraków, Poland
| | - Monika Dąbrowska
- Department of Inorganic and Analytical Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Kraków, Poland
| | - Małgorzata Starek
- Department of Inorganic and Analytical Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Kraków, Poland
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Flavin BM, Happe LE, Hatton RC. Meeting report: an exploration into the scientific and regulatory aspects of pharmaceutical drug quality in the United States. Expert Opin Drug Saf 2021; 21:167-170. [PMID: 34915789 DOI: 10.1080/14740338.2022.2020244] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The University of Florida College of Pharmacy, Department of Pharmaceutical Outcomes and Policy hosted a seminar 6-7 March 2021, on the quality of pharmaceutical products in the United States. This meeting report summarizes the topics presented at the seminar and highlights the expert opinions offered by the presenters.Areas Covered: The seminar, held virtually due to the COVID-19 pandemic, included slide presentations and faculty-moderated panel discussions from experts in the field. These experts from regulatory, academic, and private sectors discussed bioequivalence standards, existing and emerging efforts to promote quality in brand and generic manufacturing, as well as market-based solutions throughout the drug supply chain.Expert Opinion: The time spent understanding bioequivalence standards during the seminar felt especially important and relevant in our current pandemic environment, given the present need to have confidence in the science of drug development and to advocate for the safety of pharmaceuticals. Also an important point to emphasize from the seminar, was that every stakeholder along the drug supply chain has a responsibility to do their part to maintain its quality. And those in attendance, many of whom were students of healthcare sciences, were encouraged to be leaders in their fields and develop strategies to advance innovative improvements.
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Affiliation(s)
- Bridget M Flavin
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Laura E Happe
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Randy C Hatton
- College of Pharmacy, University of Florida, Gainesville, FL, USA
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Hall PE. Accessing quality-assured medicines for pregnancy complications in lower- and middle-income countries. Int J Gynaecol Obstet 2021; 154:374-375. [PMID: 34096612 DOI: 10.1002/ijgo.13748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/20/2021] [Accepted: 05/17/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Peter Edward Hall
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
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Rodriguez N, Grosso M, Galvez B, Calderon G, Lau L, Turner VA, Hidalgo IJ. Evaluation of the In-Vitro Dissolution Permeation Systems 1 (IDAS1) as a potential tool to monitor for unexpected changes in generic medicaments in poorly regulated markets. Eur J Pharm Sci 2021; 161:105791. [PMID: 33691154 DOI: 10.1016/j.ejps.2021.105791] [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: 09/02/2020] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 11/19/2022]
Abstract
Panama, like most Latin American countries, has insufficient regulatory safeguards to ensure the safety and efficacy of all pharmaceutical products in the market, a situation that results in a two-tier system, where affluent citizens can afford innovator products while poor citizens must consume 'generics' of uncertain quality. Given that one lot of each drug product is analyzed every five years during registration while commercial lots are not, and since most products are not bioequivalent but simply copies or similars, there is a concern that commercial and registration lots of these 'generics' may not be of the same quality. The objective of this study was to assess the ability of various in vitro quality control tests to detect difference among five amlodipine products available in the Panamanian market: four 'generics', made in various countries, and the innovator, made in Germany and used as reference listed drug in Panama (Pan-RLD). The innovator manufactured in the United States (US-RLD) was used to compare the two RLDs. The Content Uniformity test, 30-min Dissolution test and multiple-pH Dissolution Profiles did not show any difference among the products. However, the in vitro dissolution absorption system 1 (IDAS1) showed a statistically significant difference in the amount dissolved between Pan-RLD and three out of the four 'generics', and significantly lower permeated amount for all the 'generics' compared with Pan-RLD; only US-RLD was similar to Pan-RLD. Thus, IDAS1 showed promise as a potential tool that authorities in weakly regulated markets can use to monitor for possible lot-to-lot product changes, which can help improve the quality of pharmaceutical products available to their entire populations. The significance of the similarity between the innovators made in Germany and the United States and their difference from the 'generics' (manufactured in other countries) is not known but deserves investigation.
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Affiliation(s)
- Nelson Rodriguez
- Absorption Systems Panama, City of Knowledge, Clayton, Panama City, Panama; Current address: Departamento de Farmacia y Drogas, Ministerio de Salud, Panama City, Panama; School of Pharmacy, University of Panama, Panama City, Panama
| | - Manuel Grosso
- Absorption Systems Panama, City of Knowledge, Clayton, Panama City, Panama; Current address: Departamento de Farmacia y Drogas, Ministerio de Salud, Panama City, Panama; Medipan, S.A., Buena Vista, Colón, Rep. Panama
| | - Blanca Galvez
- Absorption Systems Panama, City of Knowledge, Clayton, Panama City, Panama; Current address: Departamento de Farmacia y Drogas, Ministerio de Salud, Panama City, Panama; Medipan, S.A., Buena Vista, Colón, Rep. Panama
| | - Ginna Calderon
- Absorption Systems Panama, City of Knowledge, Clayton, Panama City, Panama; Current address: Departamento de Farmacia y Drogas, Ministerio de Salud, Panama City, Panama
| | - Lily Lau
- Absorption Systems Panama, City of Knowledge, Clayton, Panama City, Panama; Current address: Departamento de Farmacia y Drogas, Ministerio de Salud, Panama City, Panama
| | - Vilma A Turner
- Current address: Departamento de Farmacia y Drogas, Ministerio de Salud, Panama City, Panama; School of Pharmacy, University of Panama, Panama City, Panama
| | - Ismael J Hidalgo
- Absorption Systems Panama, City of Knowledge, Clayton, Panama City, Panama; Current address: Departamento de Farmacia y Drogas, Ministerio de Salud, Panama City, Panama; Absorption Systems, L.P., Exton, PA; To Whom correspondence should be addressed
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Barton I, Avanceña ALV, Gounden N, Anupindi R. Unintended Consequences and Hidden Obstacles in Medicine Access in Sub-Saharan Africa. Front Public Health 2019; 7:342. [PMID: 31803707 PMCID: PMC6873739 DOI: 10.3389/fpubh.2019.00342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/29/2019] [Accepted: 10/30/2019] [Indexed: 01/09/2023] Open
Abstract
Many life-saving drugs are still inaccessible and unaffordable in low- and middle-income countries, particularly in Sub-Saharan Africa. This contributes to poor health outcomes, wider health and socioeconomic inequities, and higher patient spending on healthcare. While resource limitations facing national regulatory authorities (NRAs) contribute to the problem, we believe that (1) fragmented and complex drug regulations, (2) suboptimal enforcement of existing regulations, and (3) poorly designed disincentives for non-compliance play a larger role. These "unintended consequences" that are a direct result of our current regulatory regimes limit competition, keep drug costs high, and lead to shortages and the proliferation of illegitimate and unregistered drugs. While NRAs can gain a lot from increased investment in their work, regulatory harmonization and innovation can arrest and reverse the regulatory failures we still see today and improve medicine access in Africa. Unfortunately, harmonization initiatives in Sub-Saharan Africa have made modest impact and have done so slowly. We encourage greater attention and investment in harmonization and other downstream functions of NRAs. We also urge increased participation of national governments-particularly executive agencies in health and the treasury-and patient advocacy groups in advancing harmonization across the subcontinent.
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Affiliation(s)
| | - Anton L V Avanceña
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | | | - Ravi Anupindi
- Stephen M. Ross School of Business, University of Michigan, Ann Arbor, MI, United States
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Lehmann A, Hofsäss M, Dressman J. Differences in drug quality between South Africa and Germany. J Pharm Pharmacol 2018; 70:1301-1314. [PMID: 30047137 DOI: 10.1111/jphp.12985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 03/06/2018] [Accepted: 06/27/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine differences in drug product quality between products marketed in developed countries and in developing countries. METHODS The quality of drug products marketed in both Germany and South Africa by the same pharmaceutical company was compared. A fixed-dose combination tablet containing amoxicillin/clavulanic acid, and mometasone furoate nasal spray were selected to represent generic medicines requiring prescriptions, while skin lightening products (legally obtained and/or confiscated) were selected to represent pharmaceutical products that are available without a prescription. Pharmacopoeial tests included assay, content uniformity, and where applicable, dissolution in addition to a visual examination of the packaging. KEY FINDINGS Some differences between the product marketed in Germany and in South Africa were detected for the amoxicillin tablet formulations, although all samples still complied with regulatory requirements. The mometasone nasal spray product marketed in South Africa delivered a higher dose than was declared on the label. The composition of the skin lightening products conformed qualitatively with labelling, but in some South African samples alarmingly high amounts of hydroquinone were found. CONCLUSIONS Important differences in quality were detected between some German and South African products. To preclude drug products of poor or doubtful quality from entering the market in South Africa, countermeasures are needed.
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Affiliation(s)
- Andreas Lehmann
- Institute of Pharmaceutical Technology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Martin Hofsäss
- Institute of Pharmaceutical Technology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Jennifer Dressman
- Institute of Pharmaceutical Technology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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Jost J, Ratsimbazafy V, Nguyen TT, Nguyen TL, Dufat H, Dugay A, Ba A, Sivadier G, Mafilaza Y, Jousse C, Traïkia M, Leremboure M, Auditeau E, Raharivelo A, Ngoungou E, Kariuki SM, Newton CR, Preux PM. Quality of antiepileptic drugs in sub-Saharan Africa: A study in Gabon, Kenya, and Madagascar. Epilepsia 2018; 59:1351-1361. [PMID: 29893991 DOI: 10.1111/epi.14445] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Epilepsy is a major public health issue in low- and middle-income countries, where the availability and accessibility of quality treatment remain important issues, the severity of which may be aggravated by poor quality antiepileptic drugs (AEDs). The primary objective of this study was to measure the quality of AEDs in rural and urban areas in 3 African countries. METHODS This cross-sectional study was carried out in Gabon, Kenya, and Madagascar. Both official and unofficial supply chains in urban and rural areas were investigated. Samples of oral AEDs were collected in areas where a patient could buy or obtain them. Pharmacological analytical procedures and Medicine Quality Assessment Reporting Guidelines were used to assess quality. RESULTS In total, 102 batches, representing 3782 units of AEDs, were sampled. Overall, 32.3% of the tablets were of poor quality, but no significant difference was observed across sites: 26.5% in Gabon, 37.0% in Kenya, and 34.1% in Madagascar (P = .7). The highest proportions of substandard medications were found in the carbamazepine (38.7%; 95% confidence interval [CI] 21.8-57.8) and phenytoin (83.3%; 95% CI 35.8-99.5) batches, which were mainly flawed by their failure to dissolve. Sodium valproate was the AED with the poorest quality (32.1%; 95% CI 15.8-42.3). The phenobarbital (94.1%; 95% CI 80.3-99.2) and diazepam (100.0%) batches were of better quality. The prevalence of substandard quality medications increased in samples supplied by public facilities (odds ratio [OR] 9.9; 95% CI 1.2-84.1; P < .04) and manufacturers located in China (OR 119.8; 95% CI 8.7-1651.9; P < .001). The prevalence of AEDs of bad quality increased when they were stored improperly (OR 5.4; 95% CI 1.2-24.1; P < .03). SIGNIFICANCE No counterfeiting was observed. However, inadequate AED storage conditions are likely to lead to ineffective and possibly dangerous AEDs, even when good-quality AEDs are initially imported.
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Affiliation(s)
- Jeremy Jost
- INSERM, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, University of Limoges, Limoges, France
| | - Voa Ratsimbazafy
- INSERM, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, University of Limoges, Limoges, France
| | - Thu Trang Nguyen
- Laboratory of Pharmacology-UMR COMETE 8638, School of Pharmacy of Paris, University of Paris Descartes USPC, Paris, France
| | - Thuy Linh Nguyen
- Laboratory of Pharmacology-UMR COMETE 8638, School of Pharmacy of Paris, University of Paris Descartes USPC, Paris, France
| | - Hanh Dufat
- Laboratory of Pharmacology-UMR COMETE 8638, School of Pharmacy of Paris, University of Paris Descartes USPC, Paris, France
| | - Annabelle Dugay
- Laboratory of Pharmacology-UMR COMETE 8638, School of Pharmacy of Paris, University of Paris Descartes USPC, Paris, France
| | - Alassane Ba
- CHMP, Humanitarian Center for Pharmaceutical Careers, Clermont-Ferrand, France
| | - Guilhem Sivadier
- CHMP, Humanitarian Center for Pharmaceutical Careers, Clermont-Ferrand, France
| | - Yattussia Mafilaza
- CHMP, Humanitarian Center for Pharmaceutical Careers, Clermont-Ferrand, France
| | - Cyril Jousse
- Institute of Chemistry of Clermont-Ferrand (ICCF), UMR CNRS 6296, University of Clermont Auvergne, Aubière, France
| | - Mounir Traïkia
- Institute of Chemistry of Clermont-Ferrand (ICCF), UMR CNRS 6296, University of Clermont Auvergne, Aubière, France
| | - Martin Leremboure
- Institute of Chemistry of Clermont-Ferrand (ICCF), UMR CNRS 6296, University of Clermont Auvergne, Aubière, France
| | - Emilie Auditeau
- INSERM, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, University of Limoges, Limoges, France
| | - Adeline Raharivelo
- INSERM, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, University of Limoges, Limoges, France.,Joseph Raseta Befelatanana Hospital, Antananarivo, Madagascar
| | - Edgard Ngoungou
- INSERM, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, University of Limoges, Limoges, France.,Unit of Neuroepidemiology and Tropical Infectious Diseases, Department of Epidemiology, Biostatistics, University of Health Sciences, Libreville, Gabon
| | - Symon M Kariuki
- KEMRI-Welcome Trust Programme - Centre for Geographical Medicine (Coast) Kenya Medical Research Institute, Kilifi, Kenya
| | - Charles R Newton
- KEMRI-Welcome Trust Programme - Centre for Geographical Medicine (Coast) Kenya Medical Research Institute, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Pierre-Marie Preux
- INSERM, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, University of Limoges, Limoges, France
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13
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Aldridge J, Stevens A, Barratt MJ. Harms, benefits and the policing of cryptomarkets: a response to commentaries. Addiction 2018; 113:802-804. [PMID: 29468766 DOI: 10.1111/add.14169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/22/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Alex Stevens
- School of Social Policy, Sociology and Social Research, Medway Campus Chatham Maritime, University of Kent, Medway, UK
| | - Monica J Barratt
- UNSW Australia-Drug Policy Modelling Program, National Drug and Alcohol Research Centre, Sydney, New South Wales, Australia.,Curtin University, National Drug Research Institute, Perth, Western Australia, Australia
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14
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Aldridge J, Stevens A, Barratt MJ. Will growth in cryptomarket drug buying increase the harms of illicit drugs? Addiction 2018; 113:789-796. [PMID: 28766792 PMCID: PMC5947707 DOI: 10.1111/add.13899] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/10/2017] [Accepted: 06/12/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM Cryptomarkets-on-line, anonymous market-places for illicit goods and services that specialize mainly in drugs-account for a small but rapidly growing share of the illicit drug market in many countries. Policy responses so far are based generally on the assumption that their rise will only increase drug harms. In this contribution for debate, we question this assumption. METHODS We provide a narrative review of the emerging literature connected to drug cryptomarkets. We use MacCoun & Reuter's formula to understand the effect of population-level increases in use on total harm as depending on the level of harm associated with each unit of use. We then consider the potential for cryptomarkets to increase or decrease the harms and benefits related to each unit of drug use, with specific attention to the quality of drugs sold and the non-drug-related harms and benefits for customers. RESULTS It is likely that cryptomarkets will increase both the amount and the range of substances that are sold. However, we argue that the effects on harms will depend upon whether cryptomarkets also increase the quality and safety of products that are sold, provide harm-reducing information to consumers and reduce transactional conflict involved in drug purchasing. CONCLUSIONS There is an emerging and rapidly growing evidence base connected to the macro and micro harms and benefits of cryptomarkets for drug users. Future researchers should use appropriately matched comparative designs to establish more firmly the differential harms and benefits of sourcing drugs both on- and off-line. While it is unlikely that the on-line drug trade can be eradicated completely, cryptomarkets will respond to regulation and enforcement in ways that have complex, and sometimes unanticipated, effects on both harms and benefits.
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Affiliation(s)
| | - Alex Stevens
- School of Social Policy, Sociology and Social ResearchUniversity of Kent, CanterburyUK
| | - Monica J. Barratt
- Drug Policy Modelling ProgramNational Drug and Alcohol Research Centre, UNSWSydneyAustralia,National Drug Research Institute, Faculty of Health SciencesCurtin UniversityPerthAustralia,Behaviours and Health Risks ProgramBurnet InstituteMelbourneAustralia
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15
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Kaur H, Allan EL, Mamadu I, Hall Z, Green MD, Swamidos I, Dwivedi P, Culzoni MJ, Fernandez FM, Garcia G, Hergott D, Monti F. Prevalence of substandard and falsified artemisinin-based combination antimalarial medicines on Bioko Island, Equatorial Guinea. BMJ Glob Health 2017; 2:e000409. [PMID: 29082025 PMCID: PMC5652615 DOI: 10.1136/bmjgh-2017-000409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 05/16/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 01/15/2023] Open
Abstract
Introduction Poor-quality artemisinin-containing antimalarials (ACAs), including falsified and substandard formulations, pose serious health concerns in malaria endemic countries. They can harm patients, contribute to the rise in drug resistance and increase the public’s mistrust of health systems. Systematic assessment of drug quality is needed to gain knowledge on the prevalence of the problem, to provide Ministries of Health with evidence on which local regulators can take action. Methods We used three sampling approaches to purchase 677 ACAs from 278 outlets on Bioko Island, Equatorial Guinea as follows: convenience survey using mystery client (n=16 outlets, 31 samples), full island-wide survey using mystery client (n=174 outlets, 368 samples) and randomised survey using an overt sampling approach (n=88 outlets, 278 samples). The stated active pharmaceutical ingredients (SAPIs) were assessed using high-performance liquid chromatography and confirmed by mass spectrometry at three independent laboratories. Results Content analysis showed 91.0% of ACAs were of acceptable quality, 1.6% were substandard and 7.4% falsified. No degraded medicines were detected. The prevalence of medicines without the SAPIs was higher for ACAs purchased in the convenience survey compared with the estimates obtained using the full island-wide survey-mystery client and randomised-overt sampling approaches. Comparable results were obtained for full island survey-mystery client and randomised overt. However, the availability of purchased artesunate monotherapies differed substantially according to the sampling approach used (convenience, 45.2%; full island-wide survey-mystery client, 32.6%; random-overt sampling approach, 21.9%). Of concern is that 37.1% (n=62) of these were falsified. Conclusion Falsified ACAs were found on Bioko Island, with the prevalence ranging between 6.1% and 16.1%, depending on the sampling method used. These findings underscore the vital need for national authorities to track the scale of ineffective medicines that jeopardise treatment of life-threatening diseases and value of a representative sampling approach to obtain/measure the true prevalence of poor-quality medicines.
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Affiliation(s)
- Harparkash Kaur
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Louise Allan
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Ibrahim Mamadu
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Zoe Hall
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael D Green
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Isabel Swamidos
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Prabha Dwivedi
- Division of laboratory Sciences, Organic Analytical Toxicology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria Julia Culzoni
- Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, and Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Santa Fe, Argentina
| | - Facundo M Fernandez
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Guillermo Garcia
- Bioko Island Malaria Control Project, Medical Care Development International, Malabo, Equatorial Guinea
| | - Dianna Hergott
- Bioko Island Malaria Control Project, Medical Care Development International, Malabo, Equatorial Guinea
| | - Feliciano Monti
- Bioko Island Malaria Control Project, Medical Care Development International, Malabo, Equatorial Guinea
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16
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Brock AR, Gibbs CA, Ross JV, Esterman A. The Impact of Antimalarial Use on the Emergence and Transmission of Plasmodium falciparum Resistance: A Scoping Review of Mathematical Models. Trop Med Infect Dis 2017; 2:E54. [PMID: 30270911 DOI: 10.3390/tropicalmed2040054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 09/08/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 01/08/2023] Open
Abstract
The emergence and transmission of resistance to antimalarial treatments continue to hamper malaria elimination efforts. A scoping review was undertaken regarding the impact of antimalarial treatment in the human population on the emergence and transmission of Plasmodium falciparum resistance, to (i) describe the use of mathematical models used to explore this relationship; (ii) discuss model findings; and (iii) identify factors influencing the emergence and transmission of resistance. Search strategies were developed and deployed in six major databases. Thirty-seven articles met the eligibility criteria and were included in the review: nine articles modeled the emergence of resistance, 19 modeled the transmission of resistance, and nine modeled both the emergence and transmission. The proportion of antimalarial use within the population and the presence of residual drug concentrations were identified to be the main predictors of the emergence and transmission of resistance. Influencing factors pertaining to the human, parasite and mosquito populations are discussed. To ensure the prolonged therapeutic usefulness of antimalarial treatments, the effect of antimalarial drug use on the emergence and transmission of resistance must be understood, and mathematical models are a useful tool for exploring these dynamics.
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17
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Veronin MA, Nutan MT, Dodla UKR. Quantification of active pharmaceutical ingredient and impurities in sildenafil citrate obtained from the Internet. Ther Adv Drug Saf 2014; 5:180-9. [PMID: 25360239 DOI: 10.1177/2042098614543091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The accessibility of prescription drugs produced outside of the United States, most notably sildenafil citrate (innovator product, Viagra®), has been made much easier by the Internet. Of greatest concern to clinicians and policymakers is product quality and patient safety. The US Food and Drug Administration (FDA) has issued warnings to potential buyers that the safety of drugs purchased from the Internet cannot be guaranteed, and may present a health risk to consumers from substandard products. OBJECTIVE The objective of this study was to determine whether generic sildenafil citrate tablets from international markets obtained via the Internet are equivalent to the US innovator product regarding major aspects of pharmaceutical quality: potency, accuracy of labeling, and presence and level of impurities. This will help identify aspects of drug quality that may impact public health risks. METHODS A total of 15 sildenafil citrate tablets were obtained for pharmaceutical analysis: 14 generic samples from international Internet pharmacy websites and the US innovator product. According to US Pharmacopeial guidelines, tablet samples were tested using high-performance liquid chromatography for potency of active pharmaceutical ingredient (API) and levels of impurities (impurities A, B, C, and D). Impurity levels were compared with International Conference on Harmonisation (ICH) limits. RESULTS Among the 15 samples, 4 samples possessed higher impurity B levels than the ICH qualification threshold, 8 samples possessed higher impurity C levels than the ICH qualification threshold, and 4 samples possessed more than 1% impurity quantity of maximum daily dose (MDD). For API, 6 of the samples failed to fall within the 5% assay limit. CONCLUSIONS Quality assurance tests are often used to detect formulation defects of drug products during the manufacturing and/or storage process. Results suggest that manufacturing standards for sildenafil citrate generic drug products compared with the US innovator product are not equivalent with regards to potency and levels of impurities. These findings have implications for safety and effectiveness that should be addressed by clinicians to safeguard consumers who choose to purchase sildenafil citrate and foreign-manufactured drugs, in general, via the Internet.
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Affiliation(s)
- Michael A Veronin
- Texas A&M University Health Science Center Rangel College of Pharmacy - Pharmaceutical Sciences, MSC 131 1010 West Avenue B, Kingsville, TX 78363-8202, USA
| | - Mohammad T Nutan
- Texas A&M University Health Science Center Rangel College of Pharmacy - Pharmaceutical Sciences, Kingsville, TX, USA
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Abstract
Poor-quality medicines present a serious public health problem, particularly in emerging economies and developing countries, and may have a significant impact on the national clinical and economic burden. Attention has largely focused on the increasing availability of deliberately falsified drugs, but substandard medicines are also reaching patients because of poor manufacturing and quality-control practices in the production of genuine drugs (either branded or generic). Substandard medicines are widespread and represent a threat to health because they can inadvertently lead to healthcare failures, such as antibiotic resistance and the spread of disease within a community, as well as death or additional illness in individuals. This article reviews the different aspects of substandard drug formulation that can occur (for example, pharmacological variability between drug batches or between generic and originator drugs, incorrect drug quantity and presence of impurities). The possible means of addressing substandard manufacturing practices are also discussed. A concerted effort is required on the part of governments, drug manufacturers, charities and healthcare providers to ensure that only drugs of acceptable quality reach the patient.
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Affiliation(s)
- Atholl Johnston
- Clinical Pharmacology, Barts and The London School of Medicine and Dentistry, Queen Mary, University of LondonLondon, UK
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19
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Uehara K, Tagami T, Miyazaki I, Murata N, Takahashi Y, Ohkubo H, Ozeki T. Effect of X-ray exposure on the pharmaceutical quality of drug tablets using X-ray inspection equipment. Drug Dev Ind Pharm 2014; 41:953-8. [PMID: 24842380 DOI: 10.3109/03639045.2014.917093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT X-ray inspection equipment is widely used to detect missing materials and defective goods in opaque containers. Its application has been expanded to the pharmaceutical industry to detect the presence of drug tablets in aluminum foil press-through packaging. However, the effect of X-rays on the pharmaceutical quality of drug tablets is not well known. OBJECTIVE In this study, the effect of X-rays on the pharmaceutical quality of drug tablets was investigated. METHODS Exposure of acetaminophen, loxoprofen and mefenamic acid tablets to X-ray doses of 0.34 mGy (thrice the dose by X-ray scanning) to 300 Gy (maximum dose from our X-ray equipment) was demonstrated, and the samples were evaluated by formulation tests. RESULTS Exposure to X-rays did not affect the pharmaceutical quality of the drug content. The samples exposed to X-rays exhibited almost the same profile in formulation tests (dissolution test, disintegrating test and hardness test) as control samples (0 Gy). The combination of X-ray exposure with accelerated temperature and humidity tests (six months) also did not affect the pharmaceutical quality. The color change of light-sensitive drugs (nifedipine and furosemide tablets) after X-ray exposure was negligible (< 1.0). In contrast, tablet color was remarkably changed by light from a D65 lamp. CONCLUSION The X-ray scanning and X-ray exposure under our experimental conditions did not affect the pharmaceutical quality of drug tablets.
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Affiliation(s)
- Kazuaki Uehara
- Drug Delivery and Nano Pharmaceutics, Graduate School of Pharmaceutical Sciences, Nagoya City University , Mizuho-ku, Nagoya, Aichi , Japan and
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