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Liu S, Patanwala AE, Naylor JM, Levy N, Knaggs R, Stevens JA, Bugeja B, Begley D, Khor KE, Lau E, Allen R, Adie S, Penm J. Impact of modified-release opioid use on clinical outcomes following total hip and knee arthroplasty: a propensity score-matched cohort study. Anaesthesia 2023; 78:1237-1248. [PMID: 37365700 PMCID: PMC10952779 DOI: 10.1111/anae.16070] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/28/2023]
Abstract
Modified-release opioids are often prescribed for the management of moderate to severe acute pain following total hip and knee arthroplasty, despite recommendations against their use due to increasing concerns regarding harm. The primary objective of this multicentre study was to examine the impact of modified-release opioid use on the incidence of opioid-related adverse events compared with immediate-release opioid use, among adult inpatients following total hip or knee arthroplasty. Data for total hip and knee arthroplasty inpatients receiving an opioid analgesic for postoperative analgesia during hospitalisation were collected from electronic medical records of three tertiary metropolitan hospitals in Australia. The primary outcome was the incidence of opioid-related adverse events during hospital admission. Patients who received modified with or without immediate-release opioids were matched to those receiving immediate-release opioids only (1:1) using nearest neighbour propensity score matching with patient and clinical characteristics as covariates. This included total opioid dose received. In the matched cohorts, patients given modified-release opioids (n = 347) experienced a higher incidence of opioid-related adverse events overall, compared with those given immediate-release opioids only (20.5%, 71/347 vs. 12.7%, 44/347; difference in proportions 7.8% [95%CI 2.3-13.3%]). Modified-release opioid use was associated with an increased risk of harm when used for acute pain during hospitalisation after total hip or knee arthroplasty.
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Affiliation(s)
- S. Liu
- Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyNSWAustralia
- Department of PharmacyPrince of Wales HospitalRandwickNWSAustralia
| | - A. E. Patanwala
- Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyNSWAustralia
- Pharmacy DepartmentRoyal Prince Alfred HospitalCamperdownNSWAustralia
| | - J. M. Naylor
- Orthopaedic Department, Whitlam Orthopaedic Research CentreLiverpool HospitalLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - N. Levy
- Department of Anaesthesia and Peri‐operative MedicineWest Suffolk HospitalBury St. EdmundsUK
| | - R. Knaggs
- School of PharmacyUniversity of Nottingham and Primary Integrated Community ServicesNottinghamUK
| | - J. A. Stevens
- School of Clinical Medicine, St Vincent's Clinical CampusUniversity of New South WalesSydneyNSWAustralia
- School of MedicineUniversity of Notre DameSydneyNSWAustralia
| | - B. Bugeja
- Department of Pain ManagementPrince of Wales HospitalSydneyNSWAustralia
| | - D. Begley
- Department of Pain ManagementPrince of Wales HospitalSydneyNSWAustralia
| | - K. E. Khor
- Department of Pain ManagementPrince of Wales HospitalSydneyNSWAustralia
- Prince of Wales Clinical SchoolUniversity of New South Wales Medicine and HealthSydneyNSWAustralia
| | - E. Lau
- Department of PharmacySt George HospitalKogarahNSWAustralia
| | - R. Allen
- Pain Management UnitSt George HospitalKogarahNSWAustralia
| | - S. Adie
- St George and Sutherland Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - J. Penm
- Department of PharmacyPrince of Wales HospitalRandwickNWSAustralia
- Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyNSWAustralia
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Liu S, Athar A, Quach D, Patanwala AE, Naylor JM, Stevens JA, Levy N, Knaggs RD, Lobo DN, Penm J. Risks and benefits of oral modified-release compared with oral immediate-release opioid use after surgery: a systematic review and meta-analysis. Anaesthesia 2023; 78:1225-1236. [PMID: 37415284 PMCID: PMC10952256 DOI: 10.1111/anae.16085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/08/2023]
Abstract
Prescription of modified-release opioids for acute postoperative pain is widespread despite evidence to show their use may be associated with an increased risk of adverse effects. This systematic review and meta-analysis aimed to examine the available evidence on the safety and efficacy of modified-release, compared with immediate-release, oral opioids for postoperative pain in adults. We searched five electronic databases from 1 January 2003 to 1 January 2023. Published randomised clinical trials and observational studies on adults who underwent surgery which compared those who received oral modified-release opioids postoperatively with those receiving oral immediate-release opioids were included. Two reviewers independently extracted data on the primary outcomes of safety (incidence of adverse events) and efficacy (pain intensity, analgesic and opioid use, and physical function) and secondary outcomes (length of hospital stay, hospital readmission, psychological function, costs, and quality of life) up to 12 months postoperatively. Of the eight articles included, five were randomised clinical trials and three were observational studies. The overall quality of evidence was low. Modified-release opioid use was associated with a higher incidence of adverse events (n = 645, odds ratio (95%CI) 2.76 (1.52-5.04)) and worse pain (n = 550, standardised mean difference (95%CI) 0.2 (0.04-0.37)) compared with immediate-release opioid use following surgery. Our narrative synthesis concluded that modified-release opioids showed no superiority over immediate-release opioids for analgesic consumption, length of hospital stay, hospital readmissions or physical function after surgery. One study showed that modified-release opioid use is associated with higher rates of persistent postoperative opioid use compared with immediate-release opioid use. None of the included studies reported on psychological function, costs or quality of life.
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Affiliation(s)
- S. Liu
- Faculty of Medicine and HealthSchool of Pharmacy, University of SydneySydneyNSWAustralia
- Department of PharmacyPrince of Wales Hospital, RandwickSydneyNSWAustralia
| | - A. Athar
- Faculty of Medicine and Health, School of MedicineUniversity of Notre DameSydneyNSWAustralia
| | - D. Quach
- Faculty of Medical and Health Sciences, School of PharmacyUniversity of AucklandAucklandNew Zealand
| | - A. E. Patanwala
- Faculty of Medicine and Health, School of PharmacyUniversity of SydneySydneyNSWAustralia
- Department of PharmacyRoyal Prince Alfred HospitalCamperdownNSWAustralia
| | - J. M. Naylor
- Whitlam Orthopaedic Research Centre, Orthopaedic Department, Liverpool HospitalLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - J. A. Stevens
- School of Clinical Medicine, St VincentTable s Clinical CampusUniversity of New South WalesSydneyNSWAustralia
- University of Notre DameSydneyNSWAustralia
| | - N. Levy
- Department of Anaesthesia and Perioperative MedicineWest Suffolk HospitalBury St. EdmundsUK
| | - R. D. Knaggs
- School of PharmacyUniversity of Nottingham, and Primary Integrated Community ServicesNottinghamUK
| | - D. N. Lobo
- Nottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research CentreNottingham University Hospitals and University of Nottingham, Queen's Medical CentreNottinghamUK
- David Greenfield Metabolic Physiology Unit, MRC Versus Arthritis Centre for Musculoskeletal Ageing ResearchSchool of Life SciencesUniversity of Nottingham, Queen's Medical CentreNottinghamUK
| | - J. Penm
- Department of PharmacyPrince of Wales Hospital, RandwickSydneyNSWAustralia
- Faculty of Medicine and Health, School of PharmacyUniversity of SydneySydneyNSWAustralia
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Šedbarė R, Janulis V, Ramanauskiene K. Formulation and Biopharmaceutical Evaluation of Capsules Containing Freeze-Dried Cranberry Fruit Powder. Plants (Basel) 2023; 12:1397. [PMID: 36987086 PMCID: PMC10057423 DOI: 10.3390/plants12061397] [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] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 06/19/2023]
Abstract
Cranberry fruits are an important source of anthocyanins and anthocyanidins. The aim of the present study was to investigate the effect of excipients on the solubility of cranberry anthocyanins and their dissolution kinetics as well as on the disintegration time of the capsules. Selected excipients (sodium carboxymethyl cellulose, beta-cyclodextrin and chitosan) were found to affect the solubility and release kinetics of anthocyanins in freeze-dried cranberry powder. Capsule formulations N1-N9 had a disintegration time of less than 10 min, and capsule formulation N10 containing 0.200 g of freeze-dried cranberry powder, 0.100 g of Prosolv (combination of microcrystalline cellulose and colloidal silicon dioxide), and 0.100 g of chitosan had a capsule disintegration time of over 30 min. The total amount of anthocyanins released into the acceptor medium ranged from 1.26 ± 0.06 mg to 1.56 ± 0.03 mg. Capsule dissolution test data showed that the time to release into the acceptor medium was statistically significantly longer for the chitosan-containing capsule formulations compared to the control capsules (p < 0.05). Freeze-dried cranberry fruit powder is a potential source of anthocyanin-rich dietary supplements, and the choice of excipient chitosan could be a suitable solution in capsule formulations providing greater anthocyanin stability and modified release in the gastrointestinal tract.
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Affiliation(s)
- Rima Šedbarė
- Department of Pharmacognosy, Faculty of Pharmacy, Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania;
| | - Valdimaras Janulis
- Department of Pharmacognosy, Faculty of Pharmacy, Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania;
| | - Kristina Ramanauskiene
- Department of Clinical Pharmacy, Faculty of Pharmacy, Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania;
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Zielińska A, Eder P, Rannier L, Cardoso JC, Severino P, Silva AM, Souto EB. Hydrogels for modified-release drug delivery systems. Curr Pharm Des 2021; 28:609-618. [PMID: 34967292 DOI: 10.2174/1381612828666211230114755] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/01/2021] [Accepted: 12/02/2021] [Indexed: 11/22/2022]
Abstract
Hydrogels for the modified-release drug delivery systems is a continuously growing area of interest for the pharmaceutical industry. According to the global market, the use of polymers in this area is projected to reach $31.4 million by 2027. This review discusses the recent advances and perspectives of hydrogel in drug delivery systems for oral, parenteral, nasal, topical, and ophthalmic. The search strategy did in January 2021, and it conducted an extensive database to identify studies published from January 2010 to December 2020.We described the main characteristic of the polymers to obtain an ideal hydrogel for a specific route of administration and the formulations that was a highlight in the literature. It concluded that the hydrogels are a set useful to decrease the number of doses, side effects, promote adhesion of patient and enhances the bioavailability of the drugs improving the safety and efficacy of the treatment.
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Affiliation(s)
- Aleksandra Zielińska
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszyńska 32, 60-479 Poznań, Poland
| | - Piotr Eder
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznań, Poland
| | - Lucas Rannier
- Institute of Technology and Research and University of Tiradentes, Aracaju, Sergipe, Brazil
| | - Juliana C Cardoso
- Institute of Technology and Research and University of Tiradentes, Aracaju, Sergipe, Brazil
| | - Patrícia Severino
- Institute of Technology and Research and University of Tiradentes, Aracaju, Sergipe, Brazil
- Tiradentes Institute, 150 Mt Vernon St, Dorchester, MA 02125, USA
| | - Amélia M Silva
- Department of Biology and Environment, School of Life Sciences and Environment, University of Trás-os-Montes and Alto Douro (UTAD); 5001-801 Vila Real, Portugal
- Centre for Research and Technology of Agro-Environmental and Biological Sciences (CITAB), UTAD, 5001-801 Vila Real, Portugal
| | - Eliana B Souto
- CEB - Centre of Biological Engineering, University of Minho, Campus de Gualtar 4710-057 Braga, Portugal
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Jordan N, Roškar R, Grabnar I. Design of experiments and multivariate analysis approach to study dissolution stability of a modified-release drug product to support lean design strategies. Drug Dev Ind Pharm 2021; 47:1481-1488. [PMID: 34726551 DOI: 10.1080/03639045.2021.2001491] [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: 10/19/2022]
Abstract
OBJECTIVE The purpose of this paper is to present the use of Design of Experiments and multivariate analysis for evaluation of a modified-release drug product stability to support post-approval lean stability approaches. The focus of the paper was to investigate potential root-causes for acceleration of dissolution upon stability. METHODS For statistical evaluation of stability data, multiple linear regression statistics was used. The design space of the stability study was modeled using MODDE 12.1 software. For experimental set-up, parameters such as Temperature, Time, Packaging, Batch, and Active Pharmaceutical Ingredient supplier were selected. RESULTS With multiple linear regression modeling of the all generated stability data until six months, we were able to identify or confirm the Stability-related quality attributes and Shelf life limiting attributes. From the multiple linear regression correlation coefficients, we have evaluated that decrease of an antioxidant upon stability could cause potential shift in dissolution. However, main factors for accelerated dissolution can be attributed to other material and process variables. In the last part of the study, we have shown the usefulness of these methodologies for supporting lean stability approaches. With enhanced drug product knowledge, we designed two reduced long-term stability studies and showed that with 'One-half' reduced design, we would still be able to confirm 24-month shelf life. CONCLUSIONS Implementing Quality by design approaches on stability studies could reduce the need for excessive analytical testing, help to evaluate meaningfulness of the data and set a risk-based stability testing strategy.
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Affiliation(s)
- Nika Jordan
- Lek Pharmaceuticals d.d., Ljubljana, Slovenia.,University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Robert Roškar
- University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Iztok Grabnar
- University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
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Wen X, Deng Z, Xu Y, Yan G, Deng X, Wu L, Liang Q, Fang F, Feng X, Yu M, He J. Preparation and In Vitro/In Vivo Evaluation of Orally Disintegrating/ Modified-Release Praziquantel Tablets. Pharmaceutics 2021; 13:pharmaceutics13101567. [PMID: 34683860 PMCID: PMC8538324 DOI: 10.3390/pharmaceutics13101567] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/09/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022] Open
Abstract
This study was designed to develop orally disintegrating/sustained-release praziquantel (PZQ) tablets using the hot-melt extrusion (HME) technique and direct compression, and subsequently evaluate their release in in vitro and in vivo pharmacokinetics. For the extrusion process, hypromellose acetate succinate (HPMCAS)-LG was the carrier of pure PZQ, with a standard screw configuration used at an extrusion temperature of 140 °C and a screw rotation speed of 100 rpm. Differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), powder X-ray diffraction (PXRD) and Fourier-transform infrared spectroscopy (FTIR) were performed to characterize the extrudate. Orally disintegrating/sustained-release praziquantel tablets (PZQ ODSRTs) were prepared by direct compression after appropriate excipients were blended with the extrudate. The release amount was 5.10% in pH 1.0 hydrochloric acid at 2 h and over 90% in phosphoric acid buffer at 45 min, indicating the enteric-coating character of PZQ ODSRTs. Compared with the pharmacokinetics of marketed PZQ tablets (Aipuruike®) in dogs, the times to peak (Tmax), elimination half-life (t1/2λ) and mean residence time (MRT) were extended in PZQ ODSRTs, and the relative bioavailability of PZQ ODSRTs was up to 184.48% of that of Aipuruike®. This study suggested that PZQ ODSRTs may have potential for the clinical treatment of parasitosis.
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Affiliation(s)
- Xuemei Wen
- College of Animal Science and Technology, Guangxi University, Nanning 530004, China; (X.W.); (Z.D.); (Y.X.); (G.Y.); (X.D.); (L.W.); (Q.L.); (F.F.)
| | - Zhaoyou Deng
- College of Animal Science and Technology, Guangxi University, Nanning 530004, China; (X.W.); (Z.D.); (Y.X.); (G.Y.); (X.D.); (L.W.); (Q.L.); (F.F.)
| | - Yangfeng Xu
- College of Animal Science and Technology, Guangxi University, Nanning 530004, China; (X.W.); (Z.D.); (Y.X.); (G.Y.); (X.D.); (L.W.); (Q.L.); (F.F.)
| | - Guoqing Yan
- College of Animal Science and Technology, Guangxi University, Nanning 530004, China; (X.W.); (Z.D.); (Y.X.); (G.Y.); (X.D.); (L.W.); (Q.L.); (F.F.)
| | - Xin Deng
- College of Animal Science and Technology, Guangxi University, Nanning 530004, China; (X.W.); (Z.D.); (Y.X.); (G.Y.); (X.D.); (L.W.); (Q.L.); (F.F.)
| | - Liqin Wu
- College of Animal Science and Technology, Guangxi University, Nanning 530004, China; (X.W.); (Z.D.); (Y.X.); (G.Y.); (X.D.); (L.W.); (Q.L.); (F.F.)
| | - Qiuling Liang
- College of Animal Science and Technology, Guangxi University, Nanning 530004, China; (X.W.); (Z.D.); (Y.X.); (G.Y.); (X.D.); (L.W.); (Q.L.); (F.F.)
| | - Fang Fang
- College of Animal Science and Technology, Guangxi University, Nanning 530004, China; (X.W.); (Z.D.); (Y.X.); (G.Y.); (X.D.); (L.W.); (Q.L.); (F.F.)
| | - Xin Feng
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, The University of Mississippi, Oxford, MS 38677, USA;
| | - Meiling Yu
- College of Animal Science and Technology, Guangxi University, Nanning 530004, China; (X.W.); (Z.D.); (Y.X.); (G.Y.); (X.D.); (L.W.); (Q.L.); (F.F.)
- Correspondence: (M.Y.); (J.H.); Tel.: +86-771-3235635 (M.Y. & J.H.); Fax: +86-771-3270149 (M.Y. & J.H.)
| | - Jiakang He
- College of Animal Science and Technology, Guangxi University, Nanning 530004, China; (X.W.); (Z.D.); (Y.X.); (G.Y.); (X.D.); (L.W.); (Q.L.); (F.F.)
- Correspondence: (M.Y.); (J.H.); Tel.: +86-771-3235635 (M.Y. & J.H.); Fax: +86-771-3270149 (M.Y. & J.H.)
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Mandpe P, Prabhakar B, Shende P. Potential of Mirabegron and its Extended-release Formulations for the Treatment of Overactive Bladder Syndrome. Curr Drug Metab 2021; 21:79-88. [PMID: 32334500 DOI: 10.2174/1389200221666200425211139] [Citation(s) in RCA: 2] [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] [Received: 11/18/2019] [Revised: 01/14/2020] [Accepted: 02/27/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Overactive bladder syndrome is a broadly occurring urological disorder with a distressing impact on the quality of life. The commonly used antimuscarinic drugs show poor patient compliance because of unsatisfactory potency, tolerability and high occurrence of adverse effects such as dry mouth, blurred vision, constipation, dizziness etc. Mirabegron is the first approved β3-adrenoreceptor agonist, used as mono or in combination therapies for overactive bladder syndrome. OBJECTIVE The present review provides an insight into the mechanism, pharmacokinetics, toxicokinetics, clinical trials and the development of various conventional and modified-release dosage forms of mirabegron for the treatment of overactive bladder syndrome. RESULTS The clinical trials of phase II and phase III of mirabegron demonstrated symptomatic relief from the overactive bladder without disturbing the micturition cycle. To date, mirabegron showed promising results for safety, tolerability and efficacy in patients with overactive bladder syndrome. The modified-release tablet dosage form of mirabegron appear to be a proficient and suitable replacement for antimuscarinics and revealed the tremendous potential to overcome the adverse effects of conventional antimuscarinic drugs like Oxybutyline chloride ER, Detrol LA, VESIcare, etc. Conclusion: Mirabegron shows a distinct mode of action, i.e., targeting β3-adrenoreceptors and improving bladder storage without altering void contractions. The limited side effects, high safety, efficacy and tolerability of mirabegron present an adequate substitute to antimuscarinics. However, long-term analysis and clinical studies are prerequisites for assessing the safety, tolerability and efficacy profile of mirabegron.
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Affiliation(s)
- Pankaj Mandpe
- Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKM'S NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai, India
| | - Bala Prabhakar
- Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKM'S NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai, India
| | - Pravin Shende
- Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKM'S NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai, India
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Li H, Zhang M, Xiong L, Feng W, Williams RO 3rd. Bioavailability Improvement of Carbamazepine via Oral Administration of Modified-Release Amorphous Solid Dispersions in Rats. Pharmaceutics 2020; 12:E1023. [PMID: 33114739 DOI: 10.3390/pharmaceutics12111023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 08/30/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to improve the bioavailability of carbamazepine (CBZ), a poorly water-soluble antiepileptic drug, via modified-release amorphous solid dispersions (mr-ASD) by a thin film freezing (TFF) process. Three types of CBZ-mr-ASD with immediate-, delayed-, and controlled-release properties were successfully prepared with HPMC E3 (hydrophilic), L100-55 (enteric), and cellulose acetate (CA, lipophilic), defined as CBZ-ir-ASD, CBZ-dr-ASD, and CBZ-cr-ASD, respectively. A dry granulation method was used to prepare CBZ-mr-ASD capsule formulations. Various characterization techniques were applied to evaluate the physicochemical properties of CBZ-mr-ASD and the related capsules. The drug remained in an amorphous state when encapsulated within CBZ-mr-ASD, and the capsule formulation progress did not affect the performance of the dispersions. In dissolution tests, the preparations and the corresponding dosage forms similarly showed typical immediate-, delayed-, and controlled-release properties depending on the solubility of the polymers. Moreover, single-dose 24 h pharmacokinetic studies in rats indicated that CBZ-mr-ASD significantly enhanced the oral absorption of CBZ compared to that of crude CBZ. Increased oral absorption of CBZ was observed, especially in the CBZ-dr-ASD formulation, which showed a better pharmacokinetic profile than that of crude CBZ with 2.63- and 3.17-fold improved bioavailability of the drug and its main active metabolite carbamazepine 10,11-epoxide (CBZ-E).
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9
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Margan Koletic Z, Dosenovic S, Puljak L. Efficacy and safety of modified-release paracetamol for acute and chronic pain: a systematic review protocol. BMJ Open 2019; 9:e029728. [PMID: 31615797 PMCID: PMC6797249 DOI: 10.1136/bmjopen-2019-029728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 08/09/2019] [Accepted: 09/06/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Paracetamol (acetaminophen) is widely used for management of mild-to-moderate pain and reduction of fever. It is available as immediate release (IR) and modified-release (MR) formulation. In 2017, European Medicines Agency recommended a suspension of marketing of MR paracetamol in the European Union. Benefit-risk balance of these products has been assessed as negative as data showed that existing procedures for overdose management may not be efficient. Since MR paracetamol is still available in other countries (Australia and USA) and there is no available systematic review (SR) of efficacy and safety of MR paracetamol in the literature, we have decided to perform one to evaluate available data from randomised clinical trials (RCTs). METHODS AND ANALYSIS Using predefined search criteria, we will search EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform to identify RCTs evaluating efficacy and safety of MR paracetamol alone in any dose or duration for any pain. Participants are defined as adults and adolescents (over 12 years). Primary efficacy outcomes will be pain intensity, pain relief and sleep. Primary safety outcomes will be the number of patients experiencing any (serious) adverse event, the number of patients withdrawn due to adverse events and the number of patients with gastrointestinal and hepatic adverse events. Data analysis will be subdivided based on different clinical syndromes. Meta-analysis will be conducted if possible. Cochrane risk of bias (RoB) tool with seven dimensions will be used to assess RoB of individual studies. ETHICS AND DISSEMINATION This SR will include only data collected from trial reports; therefore, an ethical approval will not be sought. We will publish the protocol and our findings in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42018115769.
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Affiliation(s)
- Zeljana Margan Koletic
- Pharmacovigilance Department, Agency for Medicinal Products and Medical Devices of Croatia, Zagreb, Croatia
| | - Svjetlana Dosenovic
- Department of Anesthesiology and Intensive Care, University Hospital Split, Split, Croatia
| | - Livia Puljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Zagreb, Croatia
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Abstract
The appreciation of the unacceptable outcomes of patients with adrenal insufficiency has brought new developments in glucocorticoid replacement therapy. Efforts have moved beyond simple dose adjustments of the traditional immediate-release hydrocortisone to new formulations of hydrocortisone aimed at mimicking the circadian pattern of physiological glucocorticoid release. The present report has briefly summarized the evidence base behind recent studies that have reported benefits using modified-release preparations and set this in context for today’s clinical practice.
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Affiliation(s)
- Paul M Stewart
- Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.,Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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11
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Iqbal K, Halsby K, Murray RD, Carroll PV, Petermann R. Glucocorticoid management of adrenal insufficiency in the United Kingdom: assessment using real-world data. Endocr Connect 2019; 8:20-31. [PMID: 30562160 PMCID: PMC6330716 DOI: 10.1530/ec-18-0418] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/18/2018] [Indexed: 12/20/2022]
Abstract
Background and objectives Glucocorticoids are used to manage adrenal insufficiency (AI). We describe treatments used in the United Kingdom and real-world clinical outcomes for each treatment. Methods We used 2010-2016 primary care data from The Health Improvement Network (THIN). Descriptive analyses were conducted, and differences in variables between patients prescribed immediate-release hydrocortisone (IR HC), prednisolone or modified-release hydrocortisone (MR HC) were assessed using Fisher's exact test. Results Overall, 2648 patients were included: 1912 on IR HC (72%), 691 on prednisolone (26%) and 45 (2%) on MR HC. A total of 1174 (44.3%) had primary and 1150 (43.4%) had secondary AI. Patients on prednisolone were older (P < 0.001) and had a greater history of smoking (292/691, P < 0.001) and CVD (275/691, P < 0.001). Patients on MR HC had more PCOS (3/45, P = 0.001) and diabetes (27/45, P = 0.004). The number of GP visits/patient/year was 6.50 in IR HC, 9.54 in prednisolone and 9.11 in MR HC cohorts. The mean number of A&E visits and inpatient and outpatient hospital admissions ranged from 0.42 to 0.93 visits/patient/year. The mean number of adrenal crises/patient/year was between 0.02 and 0.03 for all cohorts. Conclusion IR HC is most commonly used for the management of AI in the United Kingdom, followed by prednisolone. Few patients receive MR HC. The prednisolone and MR HC cohorts displayed a greater prevalence of vascular risk factors compared with IR HC. The occurrence of AC and primary and secondary resource use were similar between treatment cohorts, and they indicate significant resource utilisation. Improved treatment and management of patients with AI is needed.
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Affiliation(s)
| | - Kate Halsby
- pH Associates, Marlow, UK
- Correspondence should be addressed to K Halsby:
| | - Robert D Murray
- Leeds Centre for Diabetes & Endocrinology, St James’s University Hospital, Leeds, UK
| | - Paul V Carroll
- Department of Endocrinology, Guy’s & St. Thomas’ NHS Foundation Trust, London, UK
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12
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Okwuosa TC, Pereira BC, Arafat B, Cieszynska M, Isreb A, Alhnan MA. Fabricating a Shell-Core Delayed Release Tablet Using Dual FDM 3D Printing for Patient-Centred Therapy. Pharm Res 2016; 34:427-437. [PMID: 27943014 DOI: 10.1007/s11095-016-2073-3] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [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: 10/11/2016] [Accepted: 11/21/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Individualizing gastric-resistant tablets is associated with major challenges for clinical staff in hospitals and healthcare centres. This work aims to fabricate gastric-resistant 3D printed tablets using dual FDM 3D printing. METHODS The gastric-resistant tablets were engineered by employing a range of shell-core designs using polyvinylpyrrolidone (PVP) and methacrylic acid co-polymer for core and shell structures respectively. Filaments for both core and shell were compounded using a twin-screw hot-melt extruder (HME). CAD software was utilized to design a capsule-shaped core with a complementary shell of increasing thicknesses (0.17, 0.35, 0.52, 0.70 or 0.87 mm). The physical form of the drug and its integrity following an FDM 3D printing were assessed using x-ray powder diffractometry (XRPD), thermal analysis and HPLC. RESULTS A shell thickness ≥0.52 mm was deemed necessary in order to achieve sufficient core protection in the acid medium. The technology proved viable for incorporating different drug candidates; theophylline, budesonide and diclofenac sodium. XRPD indicated the presence of theophylline crystals whilst budesonide and diclofenac sodium remained amorphous in the PVP matrix of the filaments and 3D printed tablets. Fabricated tablets demonstrated gastric resistant properties and a pH responsive drug release pattern in both phosphate and bicarbonate buffers. CONCLUSIONS Despite its relatively limited resolution, FDM 3D printing proved to be a suitable platform for a single-process fabrication of delayed release tablets. This work reveals the potential of dual FDM 3D printing as a unique platform for personalising delayed release tablets to suit an individual patient's needs.
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Affiliation(s)
- Tochukwu C Okwuosa
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, Lancashire, UK
| | - Beatriz C Pereira
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, Lancashire, UK
| | - Basel Arafat
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, Lancashire, UK
| | - Milena Cieszynska
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, Lancashire, UK
| | - Abdullah Isreb
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, Lancashire, UK
| | - Mohamed A Alhnan
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, Lancashire, UK.
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13
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Vourvahis M, Wang R, Mendes da Costa L, Wang C, Weatherley B, Mukwaya G, Tawadrous M, Heera J. Single-dose pharmacokinetics, safety, and tolerability of modified-release formulations of lersivirine in healthy subjects. Clin Pharmacol Drug Dev 2014; 3:472-6. [PMID: 27129121 DOI: 10.1002/cpdd.117] [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: 09/06/2013] [Accepted: 03/05/2014] [Indexed: 11/10/2022]
Affiliation(s)
| | - Ronnie Wang
- Pfizer Global Research and Development, Groton, CT, USA
| | | | - Cunshan Wang
- Pfizer Global Research and Development, Groton, CT, USA
| | | | | | | | - Jayvant Heera
- Pfizer Global Research and Development, Groton, CT, USA
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14
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Graudins A. Overdose with modified-release paracetamol (Panadol Osteo®) presenting to a metropolitan emergency medicine network: a case series. Emerg Med Australas 2014; 26:398-402. [PMID: 24934700 DOI: 10.1111/1742-6723.12249] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 04/29/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND There are currently no large cases series documenting poisoning with paracetamol modified-release (Panadol Osteo®, GlaxoSmithKline, Sydney, NSW, Australia). Management guidelines recommend at least two serum paracetamol concentrations 4 h apart and initiating treatment with N-acetylcysteine (NAC) if more than 10 g is ingested. OBJECTIVE To describe a cohort of Panadol Osteo® poisoning and determine if the management of identified cases was consistent with existing guidelines. METHOD Descriptive retrospective case series presenting to a metropolitan hospital network with paracetamol poisoning from October 2009 to September 2013. RESULTS There were 42 cases of Panadol Osteo® poisoning identified. Twenty-nine patients (median ingested dose 19 950 mg) were treated with NAC, of which 27 were acute single ingestions. Of NAC-treated patients, 85% (23/27) had an initial serum paracetamol concentration that was above the nomogram line. However, 15% (4/27) had an initial non-toxic concentration that later increased above the line. In 14 untreated patients (median ingested dose 7980 mg), one was an unrecognised late line-crosser with initial non-toxic serum paracetamol concentration. Only 43% (6/14) had a repeat paracetamol concentration measured. Three patients had a 4 h paracetamol >500 μmol/L. Late line-crossing was seen in the NAC-treated group at this level. In two untreated patients, NAC should have been commenced on the reported dose. CONCLUSION Most patients presenting with Panadol Osteo® poisoning requiring NAC treatment had an initial serum paracetamol concentration indicating need for treatment. A small number of late treatment nomogram line-crossers was seen on repeat paracetamol estimation. The current guideline for Panadol Osteo® poisoning would have detected all cases requiring NAC treatment.
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Affiliation(s)
- Andis Graudins
- Monash Emergency Medicine Program and Clinical Toxicology-Addiction Medicine Service, Monash Health, Melbourne, Victoria, Australia; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Döpfner M, Görtz-Dorten A, Breuer D, Rothenberger A. An observational study of once-daily modified-release methylphenidate in ADHD: effectiveness on symptoms and impairment, and safety. Eur Child Adolesc Psychiatry 2011; 20 Suppl 2:S243-55. [PMID: 21901417 DOI: 10.1007/s00787-011-0202-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ADHD affects over 5% of children worldwide. It is typically treated with stimulant medications, and methylphenidate (MPH) is the most commonly prescribed. This study investigated the effectiveness, on symptoms and impairment, and safety of Equasym XL(®), a combination of 30% immediate-release and 70% modified-release MPH, in the treatment of ADHD in daily clinical practice. This open-label, observational, post-marketing surveillance study was conducted in 169 centres in Germany. Eligible patients, aged 6-17 years, were diagnosed with ADHD and about to begin treatment with Equasym XL(®). Effectiveness was assessed by physicians using the clinical global impression (CGI) severity and improvement scales; teachers and parents completed questionnaires evaluating ADHD symptoms and behavioural problems (DAYAS, FBB-ADHD and SDQ-P). Assessments were carried out at baseline, after 1-3 and 6-12 weeks of treatment. Of 852 enrolled patients, 822 were evaluable; 25.30% were treatment naïve, 69.84% had previously received different MPH formulations, and 4.87% had received other medications. ADHD symptoms improved from baseline to last visit for the majority of patients for all outcome measures. According to physician ratings of core ADHD symptoms, 75.73% of patients showed improvements on the CGI-Improvement scale, 17.77% had no change, and 6.50% worsened. In teacher and parent ratings, the effectiveness of Equasym XL(®) was rated better than prior therapy at all measured time points across the day, particularly late morning (teachers) and early afternoon (parents). Equasym XL(®) was generally well tolerated; only 3.16% of patients permanently discontinued treatment due to adverse events. Equasym XL(®) is effective and well tolerated in daily clinical practice.
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