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Almasi J, Knoll L, Thiesen J, Krämer I. Viability of selected microorganisms in parenteral preparations for novel systemic anti-cancer therapy. J Oncol Pharm Pract 2023:10781552231179185. [PMID: 37272015 DOI: 10.1177/10781552231179185] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Risk factors for aseptic preparation of parenteral medicines encompass the growth-promoting nature of the preparation. Although many aqueous parenteral preparations do not have growth-promoting properties, inadvertently introduced microorganisms may remain viable. Knowledge about the viability of microorganisms in parenteral preparations can add useful information for assigning shelf life to preparations used to treat cancer patients. AIM The aim of the study was to assess the viability of four different facultative pathogenic microorganisms in 20 ready-to-administer parenteral preparations aseptically prepared in hospital pharmacies. METHODS Samples of 20 different biologics and small molecules for systemic anti-cancer therapy were inoculated either with different bacteria (i.e., Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecium) or with Candida albicans suspension. The resulting test concentrations were 104-105 microorganisms per mL. Aliquots of inoculated test solutions were transferred in duplicate to tryptic soy agar plates at the time points 0, 4, 24, 48, 144 h. The plates were incubated for 24 h (bacterial strains) and 72 h (C. albicans) at 37 °C and colony forming units (CFUs) were counted. RESULTS In most test solutions, especially in monoclonal antibody solutions, increased CFU counts of P. aeruginosa and unchanged or increased CFU counts of E. faecium and S. aureus were registered. Pronounced nutritive properties of monoclonal antibodies and filgrastim were not registered. Azacitidine, pixantrone and vinflunine containing test solutions revealed species-specific bacteriostatic and even bactericidal activity. All test solutions, except nivolumab and pixantrone containing solutions, showed constant or increasing CFU counts of C. albicans after incubation. CONCLUSION Viability of the selected pathogenic microorganisms was retained in most of the tested biological and small molecule preparations used to treat cancer patients. Therefore, in pharmacy departments strict aseptic conditions should be regarded and the lack of antimicrobial activity should be considered when assigning shelf life to RTA parenteral preparations.
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Affiliation(s)
- Jannik Almasi
- Department of Pharmacy, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Laura Knoll
- Department of Pharmacy, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Judith Thiesen
- Department of Pharmacy, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Irene Krämer
- Department of Pharmacy, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
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Krämer I, Goelz R, Gille C, Härtel C, Müller R, Orlikowsky T, Piening B, Schubert S, Simon A, Wolf K, Rösner B, Exner M. Good handling practice of parenterally administered medicines in neonatal intensive care units - position paper of an interdisciplinary working group. GMS Hyg Infect Control 2023; 18:Doc10. [PMID: 37261055 PMCID: PMC10227494 DOI: 10.3205/dgkh000436] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This position paper, developed by an interdisciplinary expert group of neonatologists, paediatric infectious disease physicians, clinical pharmacists and specialists for the prevention and control of nosocomial infections, describes the "Good handling practice of medicines parenterally administered to patients on NICUs". It takes equal account of patient safety and the specialties of neonatal intensive care regarding feasibility and proportionality. The overall concept is perceived as a "learning system", in which open communication within the health-care team relating to medication errors and critical incidents enables continuous development and improvement to ensure patient safety. In our opinion, pharmacists, who are responsible for the supply of ready-to-administer parenteral medicinal products for neonatal intensive care patients, as well as the hygiene staff responsible on site are integral parts of the interdisciplinary treatment team. Risks of the current clinical practice of parenteral treatment of NICU patients are discussed in detail and recommendations for safety-relevant procedures are given.
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Affiliation(s)
- Irene Krämer
- Department of Pharmacy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Rangmar Goelz
- Department of Neonatology, Tübingen University Children's Hospital, Tübingen, Germany
| | - Christian Gille
- Clinic for Neonatology, University Hospital for Paediatrics and Adolescent Medicine Heidelberg, Heidelberg, Germany
| | - Christoph Härtel
- University Hospital Würzburg, Department of Pediatrics, Würzburg, Germany
| | - Rachel Müller
- Pharmacy of Saarland University Hospital, Homburg, Germany
| | - Thorsten Orlikowsky
- Section of Neonatology and Paediatric Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Brar Piening
- Institute for Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Schubert
- Department of Pharmacy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
- Special interest group for Paediatric Pharmacy, German Society of Hospital Pharmacists (ADKA e.V.), Germany
| | - Arne Simon
- Paediatric Oncology and Haematology, Children's Hospital, Saarland University Hospital, Homburg, Germany
- German Society for Paediatric Infectiology, Berlin, Germany
| | - Katharina Wolf
- University Pharmacy, Tübingen University Hospital, Tübingen, Germany
| | - Bianka Rösner
- Charité – Universitätsmedizin Berlin, Centre for Gynaecology, Paediatrics and Adolescent Medicine, Clinic for Neonatology, Specialist Paediatric Intensive Care Nurse, Berlin, Germany
| | - Martin Exner
- Prevention and Outbreak Management/One health at the Institute of Hygiene and Public Health, WHO CC University Hospital Bonn for the Board of the German Society for Hospital Hygiene (DGKH), Bonn, Germany
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Wolf J, Alt S, Krämer I, Kahaly GJ. A NOVEL MONOCLONAL ANTIBODY DEGRADES THE THYROTROPIN RECEPTOR AUTOANTIBODIES IN GRAVES' DISEASE. Endocr Pract 2023:S1530-891X(23)00368-3. [PMID: 37080298 DOI: 10.1016/j.eprac.2023.04.002] [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: 12/01/2022] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Autoantibodies (Ab) against the thyrotropin receptor (TSH-R-Ab) are key mediators for the pathogenesis of Graves' disease (GD). TSH-R-Ab degradation was evaluated using several immunoassays within an exploratory, controlled trial in patients with GD receiving a monoclonal antibody (mAb) targeting the neonatal crystallizable fragment receptor (FcRn). METHODS Serial measurements of TSH-R-Ab serum levels were performed using three different binding and cell-based assays in GD patients either on medication or on placebo. RESULTS In contrast to placebo where no changes were observed, a 12-week mAb therapy led to an early and significant decrease (> 60%) of the serum TSH-R-Ab serum levels in patients with thyroidal and extra-thyroidal GD, as unanimously shown in all three assays. These marked changes were noted already at week seven post baseline (P<0.0001 for the binding immunoassay and for the luciferase (readout) bioassay. The three TSH-R-Ab binding and bioassays highly correlated in the samples of both study groups (binding immunoassay versus luciferase bioassay r = 0.91, P < 0.001, binding vs. cyclic adenosine monophosphate (cAMP) bioassay, r = 0.86, P < 0.001, luciferase versus cAMP bioassay, r = 0.71, P = 0.006). The serological results correlated with the course of the extra-thyroidal clinical parameters of GD, i.e. clinical activity score and proptosis. CONCLUSIONS Targeting the FcRn markedly reduces the disease-specific TSH-R-Ab in patients with GD. The novel and rapid TSH-R-Ab bioassay improves diagnosis and management of GD patients.
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Affiliation(s)
- Jan Wolf
- Molecular Thyroid Research Laboratory, Dept. of Medicine I, (JW, SA, GJK) and Department of Pharmacy (IK), Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany.
| | - Siegmund Alt
- Molecular Thyroid Research Laboratory, Dept. of Medicine I, (JW, SA, GJK) and Department of Pharmacy (IK), Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany.
| | - Irene Krämer
- Molecular Thyroid Research Laboratory, Dept. of Medicine I, (JW, SA, GJK) and Department of Pharmacy (IK), Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany.
| | - George Jean Kahaly
- Molecular Thyroid Research Laboratory, Dept. of Medicine I, (JW, SA, GJK) and Department of Pharmacy (IK), Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany.
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Linxweiler H, Thiesen J, Krämer I. Physicochemical Stability of Generic Thiotepa Concentrate and Ready-to-Administer Infusion Solutions for Conditioning Treatment. Pharmaceutics 2023; 15:pharmaceutics15020309. [PMID: 36839632 PMCID: PMC9964964 DOI: 10.3390/pharmaceutics15020309] [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: 12/16/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
The objective of this study was to determine the physicochemical in-use stability of recently approved Thiotepa Riemser concentrate in the original vial and diluted ready-to-administer (RTA) infusion solutions in prefilled glucose 5% and 0.9% NaCl polyolefin bags. Thiotepa Riemser 10 mg/mL concentrates and infusion solutions (1 mg/mL, 2 mg/mL, 3 mg/mL) were prepared in triplicate and stored at 2-8 °C or 25 °C for 14 days. Thiotepa concentrations were determined using a stability-indicating RP-HPLC assay. In parallel, pH and osmolality were measured. Sub-visible particles were counted on day 0 and 14. Thiotepa Riemser concentrate was revealed to be stable for 14 days when stored at 2-8 °C, or for 24 h when stored at 25 °C. Thiotepa concentrations in infusion solutions stored at 2-8 °C remained above 95% of the initial concentrations for at least 14 days, regardless of the type of vehicle solution. When stored at 25 °C, thiotepa infusion solutions in glucose 5% proved to be physicochemically stable for 3 days (1 mg/mL), 5 days (2 mg/mL) or 7 days (3 mg/mL). Thiotepa infusion solutions in 0.9% NaCl remained physicochemically stable for 5 days (1 mg/mL) or 7 days (2 mg/mL, 3 mg/mL). At these points in time, the specification limit of ≤0.6% monochloro-adduct was fulfilled. In parallel, an elevation of the pH values was registered. Thiotepa concentrates and infusion solutions should be stored at 2-8 °C due to temperature-dependent physicochemical stability, and for microbiological reasons. Glucose 5% infusion solution is recommended as a diluent, and stability-improving nominal 2 mg/mL to 3 mg/mL thiotepa concentrations should be obtained.
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Längericht J, Mitka KI, Hubalewska-Dydejczyk A, Krämer I, Kahaly GJ. Drug safety in thyroid eye disease - a systematic review. Expert Opin Drug Saf 2022; 21:881-912. [PMID: 35447047 DOI: 10.1080/14740338.2022.2069239] [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: 11/04/2022]
Abstract
INTRODUCTION The autoimmune-induced thyroid eye disease (TED) is a frequent extrathyroidal manifestation of Graves' disease and less frequently of Hashimoto's thyroiditis. Pathognomonic clinical signs, i.e. exophthalmos, double vision, and inflammation of the orbital tissue cause physical, ophthalmic, and socio-psychological limitations. AREAS COVERED PubMed and MeSH database were searched for specific guidelines, randomized controlled trials, prospective clinical studies, systematic reviews and meta-analyses pertaining to the safety profile of currently administered immunosuppressive agents for the treatment of TED. Occurred adverse events (AE), severe AE (SAE), side effects (SE), and severe SE (SSE) were classified according to the standardized medical dictionary for regulatory activities (MedDRA). EXPERT OPINION This novel systematic analysis offers an overview of potential AE, SAE and SE for currently recommended immunosuppressive drugs for the treatment of TED. Non-specific, anti-inflammatory drugs and more specific, targeted biologicals are treatment options for active and severe TED. Critical evaluation of the pertinent literature confirms an evidence-based, beneficial efficacy/risk ratio of the current first-line and second-line treatment recommendations endorsed by the European Society of Endocrinology. However, further large, well-conceived trials are mandatory to enhance our knowledge and experience with novel specific small molecules and/or monoclonal antibodies targeting the key autoantigens in TED.
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Affiliation(s)
- Jan Längericht
- Department of Medicine I., Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - Kamila I Mitka
- Department of Medicine I., Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany.,Department of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
| | | | - Irene Krämer
- Department of Pharmacy, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - George J Kahaly
- Department of Medicine I., Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
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Heeb RM, Erdnüß F, Reichhold J, Krämer I. Long-term stability of ready-to-use epinephrine 0.02 mg/mL injection solution in 50 mL glass vials. Pharmaceutical Technology in Hospital Pharmacy 2022. [DOI: 10.1515/pthp-2021-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
In adult intensive care patients, epinephrine is mostly administered by continuous injection with syringe pumps. The objective of this study was to investigate the physicochemical stability of pharmacy prepared ready-to-use epinephrine (E) 0.02 mg/mL injection solutions (total volume 50 mL) for assigning shelf-life.
Methods
E 0.02 mg/mL injection solution in 50 mL amber type l glass vials was produced batch-wise in the pharmacy department. Stability of the refrigerated (2–8 °C) product was investigated in real time over a period of 36 months by analyzing E concentrations, osmolality, pH, and sub-visible particles at predefined time-points. For E concentration measurements a stability-indicating, validated reversed-phase HPLC-PDA assay was used.
Results
The autoclaving process of E 0.02 mg/mL injection solution in 50 mL amber type I glass vials caused 5% loss of the active substance. The finished product remained stable over the study period of 36 months when stored refrigerated.
Conclusions
Batch-wise production of ready-to-use E injection solution 0.02 mg/mL in 50 mL amber glass vials was successfully implemented in our pharmacy department. According to the stability tests, a shelf-life of 36 months can be assigned to the finished product stored refrigerated. Studies concerning stability at room temperature would be useful.
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Affiliation(s)
- Rita Marina Heeb
- Department of Pharmacy , University Medical Center Mainz, Johannes Gutenberg-University , Langenbeckstraße 1 , D-55131 Mainz , Germany
| | - Frank Erdnüß
- Department of Pharmacy , University Medical Center Mainz, Johannes Gutenberg-University , Langenbeckstraße 1 , D-55131 Mainz , Germany
| | - Julia Reichhold
- Department of Pharmacy , University Medical Center Mainz, Johannes Gutenberg-University , Langenbeckstraße 1 , D-55131 Mainz , Germany
| | - Irene Krämer
- Department of Pharmacy , University Medical Center Mainz, Johannes Gutenberg-University , Langenbeckstraße 1 , D-55131 Mainz , Germany
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Erdnüß F, Mohr A, Krämer I. Longterm physicochemical stability of ready-to-administer human insulin injection solutions 1 I.U./mL in 50 mL plastic syringes. Pharmaceutical Technology in Hospital Pharmacy 2022. [DOI: 10.1515/pthp-2021-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
The objective of this study was to investigate the physicochemical stability of ready-to-adminster human insulin (HI) 1 I.U./mL injection solutions of two different brand products diluted with 0.9% NaCl solution under different storage conditions either in 50 mL disposable plastic syringes or as bulk solution in infusion bags.
Methods
HI test solutions 1 I.U./mL were prepared with Huminsulin® Normal 100 and Actrapid® Penfill®, diluted with 0.9% sodium chloride infusion solution, and filled in Original-Perfusor® syringes or BD® Perfusion syringes. Test solutions were stored for 90 days at 2–8 °C/dark or at 20–25 °C/diffuse room light. Bulk solutions 1 I.U./mL prepared with Huminsulin® Normal 100 were stored in two different 3 L infusion bags (Ecobag® click and ExactaMix® EVA bag) at 2–8 °C/dark for five days. HI concentrations were determined by reversed-phase high-performance liquid chromatography at predefined time points. Beside regular visual inspection, subvisible particles and pH values were measured.
Results
Ready-to-adminster Huminsulin® Normal and Actrapid® Penfill® injection solutions 1 I.U./mL prepared in 50 mL Original-Perfusor® syringes or BD® Perfusion syringes remained physicochemically stable for up to 90 days when stored at 2–8 °C/dark and for at least 14 days when kept at 20–25 °C/diffuse room light. Prefilled 3 L polyolefin infusion bags (Ecobag® click) are suitable for the preparation of Huminsulin® 1 I.U./mL bulk solutions. In ethylene vinyl acetate (EVA) bags, HI concentrations decreased rapidly.
Conclusions
Ready-to-administer Huminsulin® Normal and Actrapid® Penfill® injection solutions 1 I.U./mL can be prepared in advance by dilution with 0.9% sodium chloride infusion solution and filled into 50 mL Original-Perfusor® syringes or BD® Perfusion syringes; subsequent storage at 2–8 °C/dark is possible for up to 90 days. For preparation of bulk solutions, the prefilled polyolefin infusion bag is appropriate.
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Affiliation(s)
- Frank Erdnüß
- Department of Pharmacy , University Medical Center Mainz, Johannes Gutenberg-University , Mainz , Germany
| | - André Mohr
- Department of Pharmacy , University Medical Center Mainz, Johannes Gutenberg-University , Mainz , Germany
| | - Irene Krämer
- Department of Pharmacy , University Medical Center Mainz, Johannes Gutenberg-University , Mainz , Germany
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Mohr A, Erdnüß F, Krämer I. Physicochemical stability of human insulin 1 I.U./mL infusion solution in 50 mL polypropylene syringes. Pharmaceutical Technology in Hospital Pharmacy 2021. [DOI: 10.1515/pthp-2021-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
The objective of this study was to investigate the physicochemical stability of human insulin 1 I.U./mL injection solutions (Insuman® Rapid) diluted with 0.9% NaCl solution in 50 mL disposable three-piece polypropylene syringes and stored refrigerated or at room temperature.
Methods
1 I.U./mL test solutions were prepared with Insuman® Rapid and 0.9% sodium chloride infusion solution in 50 mL Original-Perfusor® syringes and BD® Perfusion syringes. Test solutions were stored for 90 days at 2–8 °C/dark or 48 h at 20–25 °C/diffuse room light in order to determine chemical stability. Additional test solutions were stored 28 days at 2–8 °C/dark followed by 24 h at 20–25 °C/diffuse room light to measure pH and particle counts. Human insulin concentrations were analysed by reversed-phase high-performance liquid chromatography at predefined time points. Test solutions were regularly inspected; subvisible particles and pH values were measured.
Results
Insuman® Rapid 1 I.U./mL injection solutions, stored at 2–8 °C/dark for 90 days showed a decrease of insulin content over time, regardless of the syringe type used. When kept at 20–25 °C/diffuse room light for 48 h, a slight decrease of the HI concentration was observed in both syringe types. No evidence of colour change, relevant particle formation or major pH-change was observed throughout the observation period in any test solution.
Conclusions
Insuman® Rapid 1 I.U./mL injection solutions can be prepared by dilution with 0.9% NaCl infusion solution in disposable 50 mL three-piece polypropylene syringes as suitable primary containers. Physicochemical stability has been demonstrated for at least 21 days stored at 2–8 °C/dark followed by 48 h at 20–25 °C/diffuse room light.
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Affiliation(s)
- André Mohr
- Department of Pharmacy , University Hospital Frankfurt , Goethe University , Theodor-Stern-Kai 7 , Frankfurt , Germany
| | - Frank Erdnüß
- Department of Pharmacy , University Medical Center Mainz, Johannes Gutenberg-University , Mainz , Germany
| | - Irene Krämer
- Department of Pharmacy , University Medical Center Mainz, Johannes Gutenberg-University , Mainz , Germany
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Mohr A, Krämer I. In-use stability of diluted thiamazole (methimazole) infusion solutions in prefilled 0.9% sodium chloride infusion bags for continuous infusion. Eur J Hosp Pharm 2020; 29:164-168. [PMID: 33020059 PMCID: PMC9047887 DOI: 10.1136/ejhpharm-2020-002408] [Citation(s) in RCA: 2] [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: 06/10/2020] [Revised: 07/11/2020] [Accepted: 08/11/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE In patients with severe hyperthyroidism unable to tolerate oral antithyroid therapy, diluted thiamazole infusion solutions (dose 120-240 mg) are administered by continuous infusion over 24 hours. Information about the type of diluent and compatibility/stability of the ready-to-administer thiamazole preparation is missing in the summary of product characteristics of the injection concentrate marketed in Germany. We studied the in-use stability of diluted infusion solutions over 24 hours. METHODS Thiamazol 40 mg inject. Henning was diluted in prefilled polyolefin infusion bags containing 250 mL 0.9% sodium chloride (NaCl) infusion solution and kept for 24 hours at room temperature and diffuse room light. Content of the diluted infusion solutions (0.48 and 0.96 mg/mL) was analysed every 4 hours over the course of 24 hours by reversed-phase high-performance liquid chromatography. pH was measured after 0, 12 and 24 hours. The infusion bags were regularly inspected for visible particles. Subvisible particles were measured by particle counting. RESULTS Thiamazole infusion solutions of the nominal concentrations 0.48 and 0.96 mg/mL in 0.9% NaCl diluent, kept at room temperature under diffuse room light, are physicochemically stable over a period of at least 24 hours. No evidence of colour change, particle formation or pH change was observed throughout the observation period. CONCLUSION Dilution of 120 or 240 mg doses of licensed thiamazole injection concentrate with 0.9% NaCl infusion solution in prefilled polyolefin containers is recommendable for continuous infusion over 24 hours in the treatment of thyrotoxicosis.
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Affiliation(s)
- André Mohr
- Pharmacy, University Medical Center, Mainz, Germany
| | - Irene Krämer
- Pharmacy, University Medical Center, Mainz, Germany
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Krämer I, Rosentreter J, Fried M, Kühn M. Significant interaction between high-dose methotrexate and high-dose piperacillin-tazobactam causing reversible neurotoxicity and renal failure in an osteosarcoma patient. J Oncol Pharm Pract 2020; 27:1000-1004. [PMID: 32878553 DOI: 10.1177/1078155220953878] [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: 11/16/2022]
Abstract
INTRODUCTION Pharmacokinetic interaction of high-dose methotrexate (MTX) and other concomitantly administered renally secreted medicinal products may lead to insufficient methotrexate serum level decrease and significant MTX toxicity. CASE REPORT We report the case of an 18-year-old male patient treated with high-dose MTX for an osteosarcoma and with high-dose piperacillin-tazobactam at the same time. MTX serum levels were severely elevated 24 hours after the MTX infusion and did not decrease in accordance with the specific calcium folinate rescue protocol. The patient experienced renal failure accompanied by neurological symptoms, most consistent with MTX-related renal and CNS toxicity.Management and outcome: After discontinuation of piperacillin-tazobactam, intensified calcium folinate rescue therapy, and IV hydration, the MTX serum levels decreased appropriately, and toxicity symptoms resolved. DISCUSSION Severe MTX-related toxicity, caused by drug-drug interaction, suggests that the concomitant use of high-dose MTX and high-dose piperacillin-tazobactam should be avoided generally.
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Affiliation(s)
- Irene Krämer
- Department of Pharmacy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jelena Rosentreter
- Department of Pharmacy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marius Fried
- Department of Internal Medicine III (Hematology Oncology), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael Kühn
- Department of Internal Medicine III (Hematology Oncology), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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Rosentreter J, Alt J, Fried M, Chakupurakal G, Stratmann J, Krämer I. Multi-center observational study on the adherence, quality of life, and adverse events in lung cancer patients treated with tyrosine kinase inhibitors. J Oncol Pharm Pract 2020; 27:1147-1158. [PMID: 32746691 DOI: 10.1177/1078155220946381] [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: 12/24/2022]
Abstract
INTRODUCTION Cancer patients tend to prefer oral instead of parenteral chemotherapy. To date, there is little evidence on the medication adherence in cancer patients. We investigated medication adherence to tyrosine kinase inhibitors in patients suffering from non-small cell lung cancer. METHODS Tyrosine kinase inhibitor adherence was measured electronically by MEMS® (medication event monitoring system) over at least six months. Adherence rates were calculated in terms of Dosing Compliance, Timing Compliance, Taking Compliance, and Drug Holidays. Patients were dichotomized as adherent when Dosing Compliance and Timing Compliance were ≥80%, Taking Compliance ranged between 90 and 110%, and <1 Drug Holiday was registered. Quality of life was assessed by two questionnaires (EORTC QLQ-C30 version 3.0, EORTC QLQ-LC13) at three time points. Adverse drug events were reported via patient diaries. RESULTS Out of 32 patients enrolled, data from 23 patients were evaluable. Median Dosing Compliance, Taking Compliance, and Timing Compliance adherence rates of tyrosine kinase inhibitor intake amounted to 100%, 98%, and 99%, respectively; Drug Holidays were observed in three patients. Four patients were dichotomized as non-adherent. Three of them had a twice-daily tyrosine kinase inhibitor regimen. Median quality of life scores amounted to 67 (max. 100) and remained unchanged over the study period. Fatigue and rash were the most frequently reported adverse drug events. CONCLUSION Medication adherence of non-small cell lung cancer patients treated with tyrosine kinase inhibitors was extraordinarily high and is likely to support the effectiveness of tyrosine kinase inhibitor treatment and a good quality of life over a long period of time. Adherence facilitating information and education is especially relevant for patients taking tyrosine kinase inhibitors in a twice-daily regimen.
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Affiliation(s)
- Jelena Rosentreter
- Department of Pharmacy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jürgen Alt
- Department of Internal Medicine III (Hematology, Oncology, Pneumology), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marius Fried
- Department of Internal Medicine III (Hematology, Oncology, Pneumology), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Jan Stratmann
- Department of Internal Medicine II (Hematology, Oncology), Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Irene Krämer
- Department of Pharmacy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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Abstract
Monoclonal antibody (Mabs) containing medicinal products are widely used in clinical practice. Prior to parenteral administration, licensed Mab containing medicinal products are transferred to the ready-to-administer (RTA) forms. Reconstitution and/or preparation should follow the guidelines for Good Reconstitution/Good Preparation Practice. Preparation in the pharmacy must take place within the framework of a suitable quality management system. The responsible pharmacist must apply a risk assessment on the process to ensure the appropriate quality of the RTA preparation, especially because the extent of quality testing is limited by batch size (often one single unit) and time restraints. In these cases, appropriate quality is to be assured by means of qualification activities, environmental monitoring, process validation with growth medium and in-process controls. Correct labelling of the Mab containing RTA preparations includes a suitable storage advice and a defined shelf life. Physicochemical stability of a given Mab preparation can be assessed based on a specific stability study (supplied by the manufacturer in the SmPC or scientific journals, study published by an expert in a peer-reviewed scientific journal). Physicochemical stability studies require the use of various orthogonal physicochemical methods to detect accurately the degradation changes that may result from the deamidation, oxidation, disulfide formation, aggregation or fragmentation during storage. Complementary, biological activity can be measured. Compatibility studies of Mabs and devices used for preparation and administration are still scarce. Microbiological stability of Mab preparations is related to the complexity of the preparation process, the growth supporting nature of the preparation and the integrity of the container or container/closure combination. In use viability tests revealed that the potential of Mab preparations to support microbial growth was similar to that of the pure vehicle solutions used as control solutions. The enumerated microbial counts varied according to the species utilized and the type of Mab preparation. If sterility testing of the individual preparation is impossible, maximum permitted shelf life can be assessed empirically with regard to the maximum shelf lives defined in the USP <797> monograph. Finally, microbiological and physicochemical stability are to be considered concurrently when determining the shelf life of an individual Mab preparation. In each case, shelf life should be limited according to the shorter period of proven stability, either derived from the microbiological or physicochemical stability data.
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Affiliation(s)
- Irene Krämer
- Pharmacy Department, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Judith Thiesen
- Pharmacy Department, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Alain Astier
- Pharmacy Department, Henri Mondor University Hospital, Créteil, France
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Crauste-Manciet S, Krämer I, Lagarce F, Sautou V, Beaney A, Smith J, Fenton-May V, Hecq JD, Sadeghipour F, Brun PL. GERPAC Consensus Conference – Guidance on the Assignment of Microbiological Shelf-life for Hospital Pharmacy Aseptic Preparations. Pharmaceutical Technology in Hospital Pharmacy 2020. [DOI: 10.1515/pthp-2020-0001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractAll dosage forms prepared in hospital pharmacies should be labelled with an appropriate shelf-life. This shelf-life should be validated taking chemical, physical and microbiological data into consideration. This guidance focuses on parenteral aseptically prepared products, as they are high-risk preparations. The risk is exacerbated by a requirement for longer shelf lives for reasons of economy and efficiency. The scope of this guidance includes individual patient preparations, preparations prepared in series (same type of preparation being repeatedly prepared) and batch preparations prepared from the same initial bulk admixture.
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Affiliation(s)
- Sylvie Crauste-Manciet
- ARNA U1212 INSERM UMR 5320, University of Bordeaux, 146 rue léo Saignat, Bordeaux33076, France
| | - Irene Krämer
- Department of Pharmacy, University Medical Center, Langenbeckstrasse 1, Mainz55131, Germany
| | - Frederic Lagarce
- Department of Pharmacy, University Hospital of Angers, 4 rue Larrey, Angers49033, France
| | - Valerie Sautou
- ICCF UMR 6296 CNRS, Faculty of pharmacy, 28 Place Henri Dunant, Clermont-Ferrand63000, France
| | - Alison Beaney
- Stockton QC Laboratory, University Hospital of North Tees., Harwick, Stockton, Stockton-on-TeesTS19 8PE, UK
| | - Julian Smith
- JCS Pharma Consulting Ltd, Yew Tree Cottage, Hendrew Lane, Llandevaud, Newport, Gwent, NP18 2AB, UK
| | - V’Iain Fenton-May
- Former Quality Control Pharmacist to the Welsh Hospitals Cardiff United, Cardiff, UK
| | - Jean-Daniel Hecq
- Pharmacym, CHU UCL Namur, Avenue Therasse, Yvoir, Namur5530, Belgium
| | - Farshid Sadeghipour
- Department of Pharmacy, Lausanne University Hospita, Bugnon, 46, Lausanne, VD1011, Switzerland
| | - Paul Le Brun
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Albibusdreef 2, Leiden2300 RC, Netherlands
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Hecq JD, Krämer I, Vigneron J. European Databases on Stability and Compatibility of Injectable Medicinal Products in Europe. Pharmaceutical Technology in Hospital Pharmacy 2020. [DOI: 10.1515/pthp-2019-0012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractIn hospitals, the majority of medication therapy is administered intravenously. Especially, in intensive care units, simultaneous of various injectable drugs is a common practice Drug incompatibilities have been reported to be associated with up to 60 % of all serious and life-threatening adverse drug events. Several databases are used by hospital pharmacists to answer the questions of (in)compatibility of co-administered injectable drugs. The objective of this article is to present the European databases on compatibility and stability of injectable drugs. According to a questionnaire which was sent to the National Hospital Pharmacy Associations of the 28 countries of European Community there are three national databases available in EU countries which are in alphabetical order, Belgium, France and Germany. The Belgian database is dedicated to injectable medications, is updated and distributed annually in French language on a USB key. STABILIS® is an international database giving information with pictograms translated into 29 languages. This database contains also monographs of non-injectable drugs. The internet-based ADKA STABIL-Datenbank is focused on anticancer drug therapy, listing detailed datasets in German language on stability and compatibility including the references.
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Affiliation(s)
- Jean-Daniel Hecq
- Department of Pharmacy, CHU UCL Namur
- Site Godinne, Avenue Therasse, 1, 5530Yvoir, Belgium
| | - Irene Krämer
- University Medical Center Johannes Gutenberg-University Mainz, 55131Mainz, Germany
| | - Jean Vigneron
- Meurthe et Moselle, Centre Hospitalier Universitaire de Nancy, rue du Morvan, Vandoeuvre, 54511Meurthe et Moselle, France
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Längericht J, Krämer I, Kahaly GJ. Glucocorticoids in Graves' orbitopathy: mechanisms of action and clinical application. Ther Adv Endocrinol Metab 2020; 11:2042018820958335. [PMID: 33403097 PMCID: PMC7745544 DOI: 10.1177/2042018820958335] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Graves' orbitopathy (GO) is the most frequent extrathyroidal manifestation of the autoimmune Graves' disease. GO significantly impacts quality of life and has a psycho-social morbidity. Inflammation and swelling of the orbital tissue often leads to proptosis, diplopia, and decrease of visual acuity. Due to the inflammatory background of the disease, glucocorticoids (GC) have been used as a first-line treatment for decades. METHODS PubMed and MeSH database were searched for original articles, clinical trials, reviews, and meta-analyses published between 1 January 2000 and 31 March 2020 and pertaining to both the mechanism of action and immunological effects of GC as well as to the treatment of GO by GC. The publications were evaluated according to their setting and study design. RESULTS GC act through genomic (trans-activation and trans-repression) and rapid non-genomic mechanisms. GC in general, and the intravenous (IV) administration of GC in particular, markedly decrease the activity and number of the most potent antigen-presenting dendritic cells. According to the internationally acknowledged European Thyroid Association Guidelines for the management of GO, weekly IVGC application over 12 weeks is recommended as first-line treatment for patients with active and severe GO. The daily and cumulative dose should be tailored according to clinical severity, for example, 4.5 g of IV methylprednisolone for the inflammatory component versus 7.5 g in the presence of diplopia and severe proptosis. Fast and significant improvements in orbital symptoms and signs are noted in 65-70% of patients. Long-term experience over decades, and worldwide availability at low cost, underline the clinical and therapeutic relevance of GC. Adverse events are rarely severe, dose-dependent, and usually reversible, hence easy to handle by medical investigators. Oral GC application on a daily basis is characterized by high bioavailability but reduced efficacy and increased toxicity. CONCLUSION IVGC still represents the standard of care in active/severe GO. Innovative biologicals, like monoclonal antibodies targeting the thyrotropin/Insulin-like growth factor-1 receptors or pro-inflammatory cytokines (e.g., Interleukin-6) should be compared with standard GC treatment with respect to short- and long-term efficacy, safety, costs, and global availability.
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Affiliation(s)
- Jan Längericht
- Department of Medicine I., Johannes Gutenberg University (JGU) Medical Center, Mainz, Rheinland-Pfalz, Germany
| | - Irene Krämer
- Department of Pharmacy, Johannes Gutenberg University (JGU) Medical Center, Mainz, Rheinland-Pfalz, Germany
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Adorni G, Seifert G, Buttini F, Colombo G, Stecanella LA, Krämer I, Rossi A. Aerosolization Performance of Jet Nebulizers and Biopharmaceutical Aspects. Pharmaceutics 2019; 11:pharmaceutics11080406. [PMID: 31405254 PMCID: PMC6723557 DOI: 10.3390/pharmaceutics11080406] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 07/01/2019] [Revised: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 01/01/2023] Open
Abstract
In this work, 13 jet nebulizers, some of which in different configurations, were investigated in order to identify the biopharmaceutical constraints related to the quality attributes of the medicinal products, which affect their safety, efficiency, compliance, and effectiveness. The aerosolization parameters, including the aerosol output, aerosol output rate, mass median aerodynamic diameter, and fine particle fraction, were determined according to the European Standard EN 13544-1, using sodium fluoride as a reference formulation. A comparison between the aerosol output nebulization time and the fine particle fraction displayed a correlation between the aerosol quality and the nebulization rate. Indeed, the quality of the nebulization significantly increased when the rate of aerosol emission was reduced. Moreover, the performance of the nebulizers was analyzed in terms of respirable delivered dose and respirable dose delivery rate, which characterize nebulization as the rate and amount of respirable product that could be deposited into the lungs. Depending on which of these two latter parameters was used, the nebulizers showed different performances. The differences, in terms of the rate and amount of delivered aerosol, could provide relevant information for the appropriate choice of nebulizer as a function of drug product, therapy, and patient characteristics.
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Affiliation(s)
- Greta Adorni
- Food and Drug Department, University of Parma, Parco Area delle Scienze 27/A, 43124 Parma, Italy
| | - Gerrit Seifert
- Apotheke, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Francesca Buttini
- Food and Drug Department, University of Parma, Parco Area delle Scienze 27/A, 43124 Parma, Italy
- Interdepartmental Center for Innovation in Health Products, BIOPHARMANET TEC, University of Parma, Parco Area delle Scienze 27/A, 43124 Parma, Italy
| | - Gaia Colombo
- Department of Life Sciences and Biotechnology, University of Ferrara, Via Fossato di Mortara 17/19, 44121 Ferrara, Italy
| | - Luciano A Stecanella
- Food and Drug Department, University of Parma, Parco Area delle Scienze 27/A, 43124 Parma, Italy
| | - Irene Krämer
- Apotheke, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Alessandra Rossi
- Food and Drug Department, University of Parma, Parco Area delle Scienze 27/A, 43124 Parma, Italy.
- Interdepartmental Center for Innovation in Health Products, BIOPHARMANET TEC, University of Parma, Parco Area delle Scienze 27/A, 43124 Parma, Italy.
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Federici M, Raffaelli J, Paolucci D, Schierl R, Krämer I. Efficacy of four cleaning solutions for the decontamination of selected cytotoxic drugs on the different surfaces of an automated compounding system. J Occup Environ Hyg 2019; 16:6-15. [PMID: 30230976 DOI: 10.1080/15459624.2018.1526384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The automated aseptic preparation of ready-to-administer antineoplastic drug solutions with robotic systems reduces the risk of occupational exposure. However, the surfaces in the preparation area of the robot are to be cleaned by wiping with an appropriate cleaning solution. The aim of the study was to evaluate the cleaning efficacy of four cleaning solutions on four surface materials installed in the APOTECAchemo robot. Predefined amounts of cisplatin (Cis), 5-fluorouracil (5-FU), and cyclophosphamide (CP) were intentionally spread on test plates made of stainless steel, aluminium, polyoxymethylene, and polycarbonate just as installed in the robotic system APOTECAchemo. After drying, the plates were cleaned with 0.2% ethanolic NaOH, 0.23% isopropanolic sodium dodecylsulfate (SDS-2P), 0.5% sodium hypochlorite (NaOCl), and 0.1% benzalkonium chloride (BZK) solutions following a standardized wiping protocol. Residual contamination was recovered with wipe tests, Pt was quantified by voltammetry, and 5-FU and CP was quantified by gas chromatography-tandem mass spectrometry (GC-MSMS). The mean residual contamination after cleaning and the cleaning efficacy (CE) rates were calculated and aggregated on different levels. The CE rates varied between 81.5% and 100% and lay in the majority of cases above 90%. The lowest CE rates were registered for Pt contamination. Especially on aluminium surfaces the residual contamination was high. The overall CE rates of the three different drugs and four different surface types amounted to 98.3% for NaOCl, 97.9% for SDS-2P, 96.9% for ethanolic NaOH, and 96.5% for BZK. The tested cleaning solutions proved to be higher than 90% in most cases, but none of them was able to eliminate 100% of the intentional surface contamination of three antineoplastic drugs on the test plates. The cleaning efficacy varied according to the different surface types and antineoplastic drug. Results could be used in the daily clinical practice to develop and implement effective cleaning procedures.
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Affiliation(s)
- Matteo Federici
- a Department of Pharmacy , University Medical Center, Johannes Gutenberg-University Mainz , Germany
| | | | | | - Rudolf Schierl
- d Institute and Clinic for Occupational , Social and Environmental Medicine , University Hospital Munich (LMU) , Germany
| | - Irene Krämer
- a Department of Pharmacy , University Medical Center, Johannes Gutenberg-University Mainz , Germany
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Walz-Jung H, Krämer I, Kamin W. Aerosolcharakteristika ausgewählter Druckluftvernebler für Erwachsene in Simulationsmodellen und Verneblung von Salbutamol. Pneumologie 2018; 72:820-831. [DOI: 10.1055/a-0749-5520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Zusammenfassung
Ziel Der Erfolg einer Inhalationstherapie wird durch Menge und Qualität des inhalierten Aerosols bestimmt. Die Auswahl eines Verneblers bedarf der Kenntnis der entsprechenden Aerosolcharakteristika.
Methoden Die Aerosolperformance von 9 marktüblichen Druckluftverneblern wurde in vitro in 2 Simulationsmodellen geprüft. Salbutamol (Sultanol forte® Fertiginhalat 2,5 mg/2,5 ml; GSK) wurde über 4 Minuten vernebelt. Die Outputparameter wurden mit dem Atemzugsimulator PARI Compas II (Erwachsenenmanöver nach Ph.Eur.9.0; n = 5/6 Verneblungen) und die aerodynamische Partikelgrößenverteilung mit dem Next Generation Impaktor (Ph.Eur.9.0, Copley Scientific; n = 3 Verneblungen) per HPLC bestimmt.
Ergebnisse Die Vernebler generierten deutlich unterschiedliche Abgaberaten und Aerosolspektren. Die Drug Delivery Rate (DDR) variierte zwischen 196 µg/min (PARI LC Sprint (blau)) und 67 µg/min (MIDINEB). Die aus DDR und Feinpartikelanteil ≤ 5 µm berechnete intrapulmonal deponierte Aerosolmenge (Respirable Drug Delivery Rate, RDDR) variierte um den Faktor 3,5.
Schlussfolgerungen Die Ergebnisse der In-vitro-Untersuchungen können unterstützend zur Auswahl eines geeigneten Druckluftverneblers genutzt werden. Für eine effektive Therapie und gute Compliance sollte ein Vernebler mit einer hohen RDDR gewählt werden.
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Affiliation(s)
- H. Walz-Jung
- Apotheke der Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz
| | - I. Krämer
- Apotheke der Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz
| | - W. Kamin
- Klinik für Kinder und Jugendmedizin am EVK Hamm, Hamm
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Krämer I, Federici M. Implementation and microbiological stability of dose-banded ganciclovir infusion bags prepared in series by a robotic system. Eur J Hosp Pharm 2018; 27:209-215. [PMID: 32587079 DOI: 10.1136/ejhpharm-2018-001745] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/14/2018] [Accepted: 10/18/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The implementation of dose-banding (DB) in centralised, pharmacy-based cytotoxic drug preparation units allows the preparation of standardised doses in series. The aim of this study was to evaluate the feasibility of DB for the prescribing of ganciclovir (GV) infusion solutions and to investigate the microbiological stability of dose-banded, automatically prepared ready-to-administer GV infusion bags by media-fill simulation tests and sterility tests. METHODS The frequency of prescription of GV doses was retrospectively analysed before and after implementing the DB scheme. Four dose-ranges or 'bands' and the corresponding standard doses (250, 300, 350, 400 mg) were identified. The maximum variance was set at ±10% of the individually prescribed dose. The aseptic preparation of a series of GV infusion bags was simulated with double strength tryptic soy broth as growth medium and prefilled 0.9% NaCl polyolefin infusion bags as primary packaging materials. The simulation process was performed with the APOTECAchemo robot on five consecutive days. In total, 50 infusion bags were filled, incubated and stored for 12 weeks at room temperature. The media-filled bags were visually inspected for turbidity after 2, 4, 8, 10 and 12 weeks. Following incubation, growth promotion tests were performed. During the simulation tests, airborne contamination was monitored with settle plates and microbial surface contamination with contact plates. Pooled sterility tests were performed for a series of 10 standard GV infusion bags after a 12-week storage period under refrigeration (2 °C-8 °C). RESULTS After implementation of the DB scheme, about 60% of the prescribed GV doses were prepared as standard preparations by the robotic system. The number of different GV doses was reduced by 61.8% (76 vs 29). None of the 50 media-filled bags showed turbidity after a storage period of 12 weeks, indicating the absence of microorganisms. The environmental monitoring with settle/contact plates matched the recommended limits set for cleanroom Grade A zones, except in the loading area of the robot. Media fills used for the sterility tests remained clear during the incubation period, thereby revealing sterility. Positive growth promotion tests proved the process's reliability. CONCLUSIONS A DB scheme for prescribing and preparation of standard GV infusion bags was successfully implemented. Microbiological tests of aseptic preparation of infusion bags in series by the APOTECAchemo robot revealed an adequate level of sterility and a well-controlled aseptic procedure. The sterility was maintained over extended storage periods, thereby encouraging extended beyond-use dating.
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Affiliation(s)
- Irene Krämer
- Department of Pharmacy, University Medical Centre, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Matteo Federici
- Department of Pharmacy, University Medical Centre, Johannes Gutenberg-University Mainz, Mainz, Germany
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20
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Krämer I, Federici M, Schierl R. Environmental and Product Contamination during the Preparation of Antineoplastic Drugs with Robotic Systems. Pharmaceutical Technology in Hospital Pharmacy 2018. [DOI: 10.1515/pthp-2018-0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Robotic systems are designed to minimize the exposure to antineoplastic drugs during automated preparation. However, contamination cannot be completely excluded. The aim of the study was to evaluate the contamination with antineoplastic drugs on the working surfaces and on the outer surface of the ready-to-use products (infusion bags and syringes) during automated preparation with different versions of a robot and manual preparation.
Methods
Surface contamination with platinum (Pt) and 5-fluorouracil (5-FU) was measured by wipe sampling and quantified by voltammetry for Pt and GC-MS for 5-FU. Sampling was performed on pre-defined locations in the working areas before and after preparation of standardized test products. The outer surfaces of Pt- or 5-FU-containing infusion bags and 5-FU-containing syringes were sampled without and after manual capping.
Results
Overall, the surface contamination in the working areas of the robotic system ranged from 0.4 to 114 pg/cm2 for Pt and from 1.3 to 1,250,000 pg/cm2 for 5-FU. The highest contamination levels were detected after preparation on the gripper of the robotic arm and on the surface beneath the dosing device. In most cases, measured concentrations were higher after preparation. Outer surfaces of infusion bags prepared with the robotic system were less contaminated than manually prepared bags. Contamination on the outer surface of syringes varied depending on the procedure adopted.
Conclusions
The risk of contamination is localised inside the working area of the robot. The outer surfaces of products were only marginally contaminated. Cleaning procedures of the working area are to be further investigated. An effective decontamination procedure for the working area of the robot and automated capping of filled syringes should be developed to further minimize the occupational risk.
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Affiliation(s)
- Irene Krämer
- Department of Pharmacy , University Medical Center, Johannes Gutenberg-University Mainz , Langenbeckstraße 1, 55131 , Mainz , Germany
| | - Matteo Federici
- Department of Pharmacy , University Medical Center, Johannes Gutenberg-University Mainz , Langenbeckstraße 1, 55131 , Mainz , Germany
| | - Rudolf Schierl
- Institute and Clinic for Occupational, Social and Environmental Medicine , University Hospital , LMU Munich , Munich , Germany
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Heeb RM, Stollhof B, Reichhold J, Thiesen J, Krämer I. Stability of Ready-to-Administer and Ready-to-Use Epinephrine and Norepinephrine Injection Solutions. Pharmaceutical Technology in Hospital Pharmacy 2017. [DOI: 10.1515/pthp-2017-0024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractBackgroundIn the University Medical Centre Mainz, standard concentrations are defined for medicinal products to be administered by continuous injection with syringe pumps in adult intensive care patients. The objective of this study was to evaluate the physicochemical stability of ready-to-use and ready-to-administer preparations containing Epinephrine (E) and Norepinephrine (NE) in standardized concentrations and prepared batch wise in the pharmacy department as basis for assigning shelf-lives.MethodsE 20 µg/mL and NE 10 µg/mL in disposable syringes and NE 40, 100, 200, 400 µg/ml in 50 ml amber type I glass vials were prepared batch wise and the concentrations were analyzed by stability-indicating, validated reversed-phase HPLC-PDA assays. Test solutions for long-term stability studies were stored under refrigeration (2–8 °C) for 6–12 months or at elevated temperatures (21–27 °C) light protected for up to 6 months or without light protection for up to one month. Osmolality and pH were measured on predefined intervals.ResultsThe concentrations of E in 50 mL syringes and NE in 10 mL syringes remained unchanged over a period of 6 months when stored at 2–8 °C. NE preparations of different concentrations prepared in amber glass vials remained stable over a study period of 12 months. At RT the shelf-life decreased to about 6 months and the exposure to mixed daylight at RT caused loss of stability in only few days.ConclusionsBatch wise preparation of ready-to-administer (RTA) preparations containing 20 µg/mL E or 10 µg/mL NE in disposable syringes as well as ready-to-use (RTU) preparations containing 40, 100, 200 and 400 µg/mL NE was successfully implemented in a pharmacy department. Storage of the preparations at refrigerated temperatures is required to obtain acceptable shelf-lives of 6–12 months. Elevated temperatures and especially exposure to mixed daylight significantly decreased the shelf life.
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Kim SH, Heeb RM, Krämer I. Physicochemical Stability of Reconstituted Decitabine (Dacogen®) Solutions and Ready-to-Administer Infusion Bags when Stored Refrigerated or Frozen. Pharmaceutical Technology in Hospital Pharmacy 2017. [DOI: 10.1515/pthp-2017-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractBackgroundProfound knowledge about the physicochemical stability is necessary in order to determine the “beyond-use-dates” of ready-to-administer preparations after reconstitution and dilution. This is especially true for unstable azanucleoside drugs like decitabine. The aim of this study was to determine the physicochemical stability of decitabine after reconstitution and dilution of DacogenMethodsTo determine the stability of frozen DacogenTo determine the stability of reconstituted DacogenDiluted DacogenDecitabine concentrations were determined at 0, 5, 8, 12, 24 and 48 hours after preparation. The pH-values were determined at 0, 8, 24 and 48 hours. Each sample was assayed by a validated stability-indicating reversed-phase high-performance liquid chromatography (RP-HPLC) assay with photodiode array detection.ResultsWhen test solutions of reconstituted DacogenIn reconstituted test solutions in glass vials and in diluted test solutions in infusion bags stored under refrigeration decitabine concentrations remained above 90 % of the initial concentration for 12 hours and 24 hours, respectively. Several peaks of degradation products were observed which explicitly increased over time.In all test solutions the pH-values amounted to pH 7 and remained unchanged. No particulate matter and no colour changes were observed over the test period.ConclusionsReconstituted decitabine solution (Dacogen
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Collins C, Krämer I. Evaluation of a Process Monitoring Method for Compounding Parenteral Nutrition with the Baxter EM2400 in a Hospital Pharmacy Department. Pharmaceutical Technology in Hospital Pharmacy 2017. [DOI: 10.1515/pthp-2017-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractBackgroundA method for process monitoring of the Baxter ACD, Exactamix EM2400, by chemically analyzing the concentrations of the ingredients in parenteral nutrition test preparations was evaluated.MethodsIn the study, three different test preparations were developed consisting of four ingredients varying in volume and concentration, which simulated actual PN products. Each test preparation was produced in triplicate by a trained pharmacy technician using the Exactamix EM2400 from Baxter (Baxter International Inc.). The process was repeated on three consecutive days using the same conditions. The amount of each ingredient in the test preparation was measured in an external contract laboratory using European Pharmacopoeia methods. Based on USP monographies and the Guidelines on the Safe Use of Automated Compounding Devices for the Preparation of Parenteral Nutrition from the ASHP the device was tested to be accurate to deliver within 5 % of the amount programmed.ResultsThe study showed that in most cases the ingredient delivery of the automated compounder deviated less than 3 % from the expected concentrations. For certain ingredients out of specification results were detected and analyzed. By resetting the flow factor, it was possible to optimize the performance of the ACD.ConclusionThe study emphasizes the need for process monitoring of the Exactamix EM2400 during the initial installation and on a regular basis for each ingredient to ensure the accurate delivery of ingredients. Further methods need to be analyzed to determine the most feasible method to regularly conduct process monitoring tests on an ACD in a hospital pharmacy setting.
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Kim SH, Krämer I. Physicochemical stability of carfilzomib (Kyprolis®) containing solutions in glass vials, ready-to-administer plastic syringes and infusion bags over a 28-day storage period. J Oncol Pharm Pract 2017; 25:1078155217735881. [PMID: 29059027 DOI: 10.1177/1078155217735881] [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] [Indexed: 11/17/2022]
Abstract
Centralized aseptic preparation of ready-to-administer carfilzomib containing parenteral solutions in plastic syringes and polyolefine (PO) infusion bags needs profound knowledge about the physicochemical stability in order to determine the beyond-use-date of the preparations. Therefore, the purpose of this study was to determine the physicochemical stability of carfilzomib solution marketed as Kyprolis® powder for solution for infusion. Reconstituted solutions and ready-to-administer preparations of Kyprolis® stored under refrigeration (2-8℃) or at room temperature (25℃) were analyzed at predetermined intervals over a maximum storage period of 28 days. Chemical stability of carfilzomib was planned to be determined with a stability-indicating reversed-phase high-performance liquid chromatography assay. Physicochemical stability was planned to be determined by visual inspection of clarity and color as well as pH measurement. The study results show that reconstituted carfilzomib containing parenteral solutions are stable in glass vials as well as diluted solutions in plastic syringes and PO infusion bags over a period of at least 28 days when stored light protected under refrigeration. When stored at room temperature, reconstituted and diluted carfilzomib solutions are physicochemically stable over 14 days and 10 days, respectively. The physicochemical stability of carfilzomib infusion solutions allows cost-saving pharmacy-based centralized preparation of ready-to-administer preparations.
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Affiliation(s)
- Sun Hee Kim
- Department of Pharmacy, University Medical Center Mainz, 39068 Johannes Gutenberg-University, Mainz , Germany
| | - Irene Krämer
- Department of Pharmacy, University Medical Center Mainz, 39068 Johannes Gutenberg-University, Mainz , Germany
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Yaniv AW, Orsborn A, Bonkowski JJ, Chew L, Krämer I, Calabrese S, de la Paz Pacheco Ramos M, Palombi A, Lim SW, Tabbara O, Masini C, Schierl R, Bufarini C, Peaty N, Paolucci D. Robotic i.v. medication compounding: Recommendations from the international community of APOTECAchemo users. Am J Health Syst Pharm 2016; 74:e40-e46. [PMID: 28007720 DOI: 10.2146/ajhp151027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 11/23/2022] Open
Abstract
PURPOSE The development of recommendations for advancing automated i.v. medication compounding is described. SUMMARY Managing the shift from manual to robotic compounding of i.v. therapies requires an awareness of how automation affects practice and how to best implement robotics into current practice. An international panel of pharmacy professionals, researchers, and technology leaders with experience in i.v. robotics collaborated during a two-day meeting in August 2014 to define a general set of principles to broaden the understanding of the fundamental elements of robotic compounding worldwide. Participants were divided into four working groups (technology and safety; drugs and products; personnel; and facilities and quality) to analyze specific aspects of robotic compounding practice. The four working groups produced an initial list of 92 statements. This list was condensed to 35 statements by consolidating similar and overlapping statements from the different work groups. Participants were surveyed again to assess agreement with the 35 statements and solicit additional clarification. Respondents expressed full agreement with 25 recommendations. Six statements received one or more "don't know" responses, with all other respondents in agreement. Four statements had a combination of "don't know" and "disagree" responses. A total of 32 comments were recorded in free-text fields, including requests for clarification and suggestions for rewording the statements. CONCLUSION An international panel of pharmacy professionals, researchers, and technology leaders with experience in i.v. robotics developed a set of 35 recommendations toward a better understanding of the role of automated i.v. compounding in hospital and health-system pharmacies worldwide.
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Affiliation(s)
| | | | | | - Lita Chew
- National University of Singapore, Singapore.,National Cancer Centre Singapore, Singapore, Singapore
| | - Irene Krämer
- Pharmacy Department, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | | | | | | | - Siew Woon Lim
- Pharmacy Department, National University Hospital, Singapore, Singapore
| | - Osama Tabbara
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Carla Masini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Rudolf Schierl
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig Maximilian University of Munich, Muenchen, Germany
| | | | - Nate Peaty
- Wake Forest Baptist Medical Center, Winston-Salem, NC
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Abstract
Purpose The aim of this study was to determine the compatibility of epirubicin-loaded DC bead™ with different non-ionic contrast media over a period of seven days when stored light protected under refrigerated conditions. Methods DC bead™ (2 ml) (Biocompatibles UK Ltd) of the bead size 70–150 µm ( = DC bead M1) or bead size 100–300 µm were loaded with 75 mg epirubicin powder formulation (Farmorubicin® dissolved in 3 ml water for injection to a concentration of 25 mg/ml) or 76 mg epirubicin injection solution (Epimedac® 2 mg/ml) within 2 h or 6 h, respectively. After removal of the excess solution, the epirubicin-loaded beads were mixed in polypropylene syringes with an equal volume (∼1.5 ml) of contrast media, i.e. Accupaque™ 300 (Nycomed Inc.), Imeron® 300 (Bracco S.p.A), Ultravist® 300 (Bayer Pharma AG), Visipaque™ 320 (GE Healthcare) and agitated in a controlled manner to get a homogenous suspension. Syringes with loaded beads in contrast media were stored protected from light under refrigeration (2–8℃). Compatibility was determined by measuring epirubicin concentrations in the suspensions in triplicate on day 0, 1, and 7. A reversed phase high-performance liquid chromatography assay with ultraviolet detection was utilized to analyze the concentration and purity of epirubicin. Results Mixing of epirubicin-loaded beads with different non-ionic contrast media released 0.1–0.5% of epirubicin over a period of 24 h, irrespectively, of the DC bead™ size or type of contrast media. No further elution or degradation was observed after seven days when the admixtures were stored protected from light under refrigeration. Conclusion Compatibility of epirubicin-loaded DC bead™ with an equal volume of different contrast media in polypropylene syringes is given over a period of seven days. Due to a maximum elution of 0.1–0.5% of epirubicin from loaded DC bead™, admixtures with contrast media can be prepared in advance in centralized cytotoxic preparation units. Microbiological aspects have to be considered when determining the expiration date of the product.
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Affiliation(s)
- Iman Sarakbi
- Department of Pharmacy, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße, Mainz, Germany
| | - Irene Krämer
- Department of Pharmacy, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße, Mainz, Germany
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Abstract
Purpose. The purpose of this study was to determine the physicochemical stability of topotecan after reconstitution and after further dilution in two commonly used infusion fluids (0.9% sodium chloride, 5% dextrose) in both polyvinylchloride (PVC) bags and elastomeric portable infusion devices. Methods. Each vial of topotecan (Hycamtin®) was reconstituted with sterile water for injection, yielding a nominal concentration of 1 mg/mL. Topotecan infusion solutions were aseptically prepared by further dilution of reconstituted topotecan solutions with either 0.9% sodium chloride or 5% dextrose in both PVC bags and portable elastomeric infusion devices, in amounts yielding topotecan concentrations of 10 µg/mL, 25 µg/mL, or 50 µg/mL. Test solutions were stored light-protected at room temperature (25°C) or under refrigeration (2-8°C) in parallel. One test solution of the nominal concentration of 10 µg/mL topotecan in a 0.9% sodium chloride PVC infusion bag was stored under ambient light conditions (mixed daylight and normal laboratory fluorescent light) at room temperature. Topotecan concentrations were obtained periodically throughout a 4-week storage period via a stability-indicating high performance liquid chromatography assay with ultra-violet detection. In addition, measurements of pH values were performed regularly, and test solutions were visually examined for colour change and precipitation. Results. The stability tests revealed that the currently available topotecan formulation is stable (at a level of ≥90% topotecan) after reconstitution and dilution, independent of temperature (refrigerated, room temperature), the vehicle (0.9% sodium chlo-ride, 5% dextrose), the concentration (10 µg/mL, 25 µg/mL, or 50 µg/mL), or the container material (PVC bags, elastomeric portable infusion devices). The results were obtained over a test period of ≥4 weeks. Topotecan infusion solutions exposed to daylight were stable for only 17 days. Conclusions. Reconstituted and diluted topotecan infusion solutions are shown to be physicochemically stable for 4 weeks. Light protection during administration is not necessary.
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Affiliation(s)
- Irene Krämer
- Department of Pharmacy, Johannes Gutenberg University Hospital, Mainz,
Germany
| | - Judith Thiesen
- Department of Pharmacy, Johannes Gutenberg University Hospital, Mainz,
Germany
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Abstract
Introduction. In determining the expiration-dates of ready-to-use antineoplastic and antiviral drug solu tions, microbiological aspects must be considered. This is especially true because many antineoplastic drugs introduced into the market are already known to lack antimicrobial activity. The purpose of this study is to evaluate the growth of four different microorganisms in ready-to-use solutions of 14 differ ent novel antineoplastic and antiviral drugs. Methods. The lowest concentrations of 14 dif ferent antineoplastic and antiviral drugs prescribed in our hospital were prepared in polyvinyl chloride bags or a polyethylene container (paclitaxel) containing 0.9% sodium chloride or 5% dextrose solution. Inoc ulations were performed by adding 9 mL of a freshly prepared drug solution to a 1 mL suspension of bacteria or fungi (Staphylococcus aureus, Enterococ cus faecium, Pseudomonas aeruginosa, Candida albicans). Resulting concentrations were about 104 microorganisms per milliliter. Pure 0.9% sodium chlo ride and 5% dextrose solutions served as positive controls. Inoculated solutions were stored at elevated temperatures (22°C or 37°C). Samples of each test solution were withdrawn at 0, 15, 30, and 60 minutes and at 2, 3, 4, 24, 48, and 120 hours after inoculation, transferred to tryptic soy agar, and incubated at 37°C. After 24 hours, colony-forming units were counted. Results. In the concentrations tested, no antimi crobial activity was registered with most of the drugs tested. There were only two cases of significant antibacterial activity, involving treosulfan and oxali platin against P. aeruginosa, respectively. Moderate antifungal activity was seen with foscarnet, ganciclo vir, pentostatin, and treosulfan. Conclusions. The lack of antimicrobial proper ties should be considered when assigning extended expiration dates to ready-to-use antineoplastic and antiviral drug solutions. Solutions should be kept under refrigeration whenever possible to minimize the growth of any contaminating microorganism. With the exception of treosulfan, end-product steril ity testing may be performed without further dilution or inactivation.
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Affiliation(s)
- Irene Krämer
- Department of Pharmacy, Johannes Gutenberg University Hospital, Mainz, Germany
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Abstract
Purpose. To determine the physicochemical stability of irinotecan injection concentrate and irinotecan infusion solutions after dilution in two commonly used infusion fluids (0.9% sodium chloride, 5% dextrose) in PVC bags, stored under refrigeration (2-8°C) or at room temperature either light protected or exposed to light. Methods. Stability of irinotecan injection concentrate was determined in the original amber glass vials. Diluted irinotecan infusion solutions were aseptically prepared by further dilution of irinotecan stock solution with either 0.9% sodium chloride or 5% dextrose in PVC bags, in amounts yielding irinotecan concentrations of 0.4, 1.0, or 2.8 mg/ml. Test solutions were stored under refrigeration (2-8°C) or at room temperature either light protected or exposed to light (mixed daylight and normal laboratory fluorescent light) in parallel. Irinotecan concentrations were determined periodically throughout a 4-week storage period via a stability-indicating HPLC assay with ultraviolet detection. In addition, measurements of pH values were performed regularly and test solutions were visually examined for colour change and precipitation. Results. Irinotecan injection concentrate and infusion solutions are shown to be physicochemically stable (at a level of >90% irinotecan) for 4 weeks when stored under refrigeration or light protected at room temperature, independent of the vehicle (0.9% sodium chloride, 5% dextrose) or the concentration (0.4, 1.0, or 2.8 mg/ml). Irinotecan infusion solutions exposed to daylight exhibited concentration-dependent instability, solutions were stable for only 7 to 14 days. Conclusions. Irinotecan injection concentrate and diluted infusion solutions are shown to have adequate physicochemical stability for convenient pharmacy-based centralized preparation.
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Affiliation(s)
- Judith Thiesen
- Department of Pharmacy, Johannes Gutenberg University Hospital, Mainz, Germany
| | - Irene Krämer
- Department of Pharmacy, Johannes Gutenberg University Hospital, Mainz, Germany
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Riedl M, Kuhn A, Krämer I, Kolbe E, Kahaly GJ. Prospective, systematically recorded mycophenolate safety data in Graves' orbitopathy. J Endocrinol Invest 2016; 39:687-94. [PMID: 26886940 DOI: 10.1007/s40618-016-0441-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/02/2016] [Indexed: 12/17/2022]
Abstract
CONTEXT The antiproliferative mechanism of mycophenolate acid (MPA) suggests a beneficial effect in patients with Graves' orbitopathy (GO). OBJECTIVE To systematically analyze for the first time adverse events (AEs) during MPA treatment in GO. DESIGN Prospective longitudinal study. SETTING Academic tertiary referral center with a joint thyroid-eye clinic. PATIENTS Fifty-three consecutive, unselected patients with clinically active and moderate-to-severe GO. METHODS MPA 0.720 g was given once daily for 24-weeks in GO patients. AEs were documented and coded according to the standardized medical dictionary for regulatory activities (MedDRA). AE were followed up and seriousness as defined by ICH-guideline E6 was documented. All AEs were analyzed regarding a possible underlying cause and if not, graded as side effect (SE). RESULTS Fifty GO patients (93 %) had Graves' disease, 37 (70 %) and 29 (54.7 %) were female and smoker, respectively. Thirty-six patients (68 %) reported at least one AE. A total of 88 AEs were documented, most frequent AEs were insomnia (N = 6), fatigue (N = 5) and optic neuropathy (N = 5), while other AEs occurred in up to three patients (5.6 %), only. In 12 (23 %) patients, at least one SE occurred. All 17 reported SE, i.e. mild infections and gastrointestinal intolerance were within the known safety profile of MPA. No patient dropped MPA medication because of drug-induced SE. Most AEs showed a recovered (76 %) or recovering (16 %) outcome. Seven (13 %) patients were hospitalized, five (62 %) due to optic neuropathy, none of these events was graded as SE. CONCLUSIONS MedDRA-coded data documented the good tolerance of a moderate MPA dose in GO patients.
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Affiliation(s)
- M Riedl
- Departments of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
- Interdisciplinary Center for Clinical Trials, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - A Kuhn
- Interdisciplinary Center for Clinical Trials, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - I Krämer
- Pharmacy Department, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - E Kolbe
- Departments of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - G J Kahaly
- Departments of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany.
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Kim SH, Thiesen J, Krämer I. Physicochemical Stability of Mozobil® (Plerixafor) Solution for Injection in Glass Vials and Plastic Syringes over a Three-Month Storage Period. Pharmaceutical Technology in Hospital Pharmacy 2016. [DOI: 10.1515/pthp-2016-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract: The stability of ready-to-administer parenteral preparations is an important issue of drug safety. Profound knowledge about the physicochemical stability is necessary in order to determine the “beyond-use-dates” of solutions in injection vials after first opening and ready-to-administer preparations in syringes.: The aim of this study was to determine the physicochemical stability of plerixafor solution marketed as Mozobil: The stability of Mozobil: No plerixafor degradation products were detected in the HPLC chromatograms over the period of 84 days, independent of the storage temperature. In vials and syringes plerixafor concentrations declined less than 5 % over the entire test period of 84 days. The pH values remained unchanged; the mean values varied between 6.79 and 6.60 for Mozobil: Plerixafor injection solution (Mozobil
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Sarakbi I, Heeb R, Thiesen J, Krämer I. Viability of Selected Microorganisms in Non-Cytotoxic Aseptic Preparations. Pharmaceutical Technology in Hospital Pharmacy 2016. [DOI: 10.1515/pthp-2015-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract: Numerous ready-to-use parenteral solutions are aseptically prepared in pharmacy-based aseptic preparation units. Microbiological stability of the preparations is influenced by the cleanroom environment, the complexity of the aseptic process, conditions during administration and the microbiological vulnerability of the products.: The aim of the study was to evaluate the ability of four different pathogens related to hospital infections to grow in ready-to-use, non-cytotoxic parenteral products aseptically prepared in hospital pharmacies.: In four consecutive series the antimicrobial activity of the following products was tested: caspofungin 35 mg or 70 mg in 250 mL 0.9 % NaCl solution (NS), micafungin 0.5 mg/mL in NS, vancomycin 5 mg/mL in G5/G10, heparin-sodium 1 IE/mL in NS, epinephrine 0.02 mg/mL in G5, norepinephrine 0.01 mg/mL in G5, phenylephrine 0.1 mg/mL, KCl solution 0.8 mmol/mL, trace elements 1:1 in G5/G10, midazolam 1 mg/mL injection solution, tranexamic acid 100 mg/mL injection solution, 50 % glucose solution, SMOFlipid 20 % lipid emulsion, 1 % propofol injection.Nine milliliter aliquots of each test solution were inoculated with 1 mL suspension of selected strains, i. e.: Most of the tested preparations induced no growth inhibition of the tested organisms. The selected strains lost viability in preparations containing vancomycin, phenylephrine or midazolam after a period of a few hours or days. Glucose 50 % w/v solution generated antimicrobial activity against: The lack of antimicrobial properties of ready-to-use, non-cytotoxic solutions should be considered while determining the shelf-life of the products. Ready-to-use preparations should be kept refrigerated whenever possible to inhibit the multiplication of any contaminating organism.
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Sarakbi I, Thiesen J, Krämer I. Compatibility of irinotecan-loaded DC Bead with different volumes and types of non-ionic contrast media. Eur J Hosp Pharm 2016; 23:38-43. [PMID: 31156812 DOI: 10.1136/ejhpharm-2015-000668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/18/2015] [Accepted: 07/22/2015] [Indexed: 11/04/2022] Open
Abstract
Objectives Irinotecan-loaded microspheres are used for simultaneous embolisation and chemotherapy of liver metastases of colorectal carcinoma. The aim of the study was to evaluate the compatibility of recently introduced DC BeadM1 (bead size 70-150 µm) loaded with irinotecan after admixture with different types and volumes of non-ionic contrast media over a maximum period of 24 h and storage at room temperature. Methods Test suspensions were prepared by loading 2 mL DC BeadM1 with 100 mg irinotecan within 2 h. The loading efficiency was determined by measuring the concentrations of irinotecan in the excess solutions via a reversed phase high pressure liquid chromatography (RP-HPLC) assay with ultraviolet detection. The compatibility of irinotecan-loaded DC BeadM1 with different types and volumes of contrast media was studied by mixing 2 mL loaded bead slurry each with up to four different volumes (5, 10, 20, 30 mL) of seven different contrast media. Samples were withdrawn after 30 min, 1, 2, 4, 8 and 24 h. Admixtures were stored light protected at room temperature over the observation period. The concentrations of eluted irinotecan were measured in triplicate samples using the RP-HPLC assay. Results Mixing of irinotecan loaded beads with non-ionic contrast media decreased the irinotecan loading efficiency between minimum 2.5% and maximum 17% over the observation period of 24 h. The rate and amount of irinotecan eluted from the beads varied relying on the type and volume of contrast medium admixed. However, no further elution or degradation was observed after the rapid release during the first 8 h. Conclusions Because of the rapid and extensive release of irinotecan, it is not recommendable to prepare admixtures of irinotecan-loaded DC BeadM1 with contrast media in centralised cytotoxic preparation units in advance. Admixture should be performed with the smallest possible amount by the radiologists immediately prior to the delivery procedure.
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Affiliation(s)
- Iman Sarakbi
- Department of Pharmacy, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Judith Thiesen
- Department of Pharmacy, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Irene Krämer
- Department of Pharmacy, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
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Ricci MS, Frazier M, Moore J, Cromwell M, Galush WJ, Patel AR, Adler M, Altenburger U, Grauschopf U, Goldbach P, Fast JL, Krämer I, Mahler HC. In-use physicochemical and microbiological stability of biological parenteral products. Am J Health Syst Pharm 2015; 72:396-407. [PMID: 25694415 DOI: 10.2146/ajhp140098] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Margaret Speed Ricci
- Margaret Speed Ricci, Ph.D., is Director of Process Development, Drug Product Development, Genentech, South San Francisco, CA. Michelle Frazier, M.S., is Director, Regulatory Affairs, Amgen, Thousand Oaks, CA. Jamie Moore, Ph.D., is Director, Early-Stage Pharmaceutical Development; Mary Cromwell, Ph.D., is Director, Late-Stage Pharmaceutical Development; William J. Galush, Ph.D., is Scientist, Late-Stage Pharmaceutical Development; and Ankit R. Patel, Ph.D., is Scientist, Early-Stage Pharmaceutical Development, Pharmaceutical Development, Pharma Technical Development Biologics U.S., Genentech, South San Francisco, CA. Michael Adler, Ph.D., is Head, Late-Stage Pharmaceutical and Processing Development; Ulrike Altenburger, Ph.D., is Head, Early-Stage Pharmaceutical Development and GLP Tox Supplies; Ulla Grauschopf, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; Pierre Goldbach, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; and Jonas L. Fast, Ph.D., is Group Leader, Early-Stage Pharmaceutical Development and GLP Tox Supplies, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd., Basel, Switzerland. Irene Krämer, Ph.D., is Director, Pharmacy Department, Medical Center of Johannes Gutenberg-University Hospital, Mainz, Germany, and Professor of Clinical Pharmacy, Pharmacy School of Johannes Gutenberg-University, Mainz. Hanns-Christian Mahler, Ph.D., is Head, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd
| | - Michelle Frazier
- Margaret Speed Ricci, Ph.D., is Director of Process Development, Drug Product Development, Genentech, South San Francisco, CA. Michelle Frazier, M.S., is Director, Regulatory Affairs, Amgen, Thousand Oaks, CA. Jamie Moore, Ph.D., is Director, Early-Stage Pharmaceutical Development; Mary Cromwell, Ph.D., is Director, Late-Stage Pharmaceutical Development; William J. Galush, Ph.D., is Scientist, Late-Stage Pharmaceutical Development; and Ankit R. Patel, Ph.D., is Scientist, Early-Stage Pharmaceutical Development, Pharmaceutical Development, Pharma Technical Development Biologics U.S., Genentech, South San Francisco, CA. Michael Adler, Ph.D., is Head, Late-Stage Pharmaceutical and Processing Development; Ulrike Altenburger, Ph.D., is Head, Early-Stage Pharmaceutical Development and GLP Tox Supplies; Ulla Grauschopf, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; Pierre Goldbach, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; and Jonas L. Fast, Ph.D., is Group Leader, Early-Stage Pharmaceutical Development and GLP Tox Supplies, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd., Basel, Switzerland. Irene Krämer, Ph.D., is Director, Pharmacy Department, Medical Center of Johannes Gutenberg-University Hospital, Mainz, Germany, and Professor of Clinical Pharmacy, Pharmacy School of Johannes Gutenberg-University, Mainz. Hanns-Christian Mahler, Ph.D., is Head, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd
| | - Jamie Moore
- Margaret Speed Ricci, Ph.D., is Director of Process Development, Drug Product Development, Genentech, South San Francisco, CA. Michelle Frazier, M.S., is Director, Regulatory Affairs, Amgen, Thousand Oaks, CA. Jamie Moore, Ph.D., is Director, Early-Stage Pharmaceutical Development; Mary Cromwell, Ph.D., is Director, Late-Stage Pharmaceutical Development; William J. Galush, Ph.D., is Scientist, Late-Stage Pharmaceutical Development; and Ankit R. Patel, Ph.D., is Scientist, Early-Stage Pharmaceutical Development, Pharmaceutical Development, Pharma Technical Development Biologics U.S., Genentech, South San Francisco, CA. Michael Adler, Ph.D., is Head, Late-Stage Pharmaceutical and Processing Development; Ulrike Altenburger, Ph.D., is Head, Early-Stage Pharmaceutical Development and GLP Tox Supplies; Ulla Grauschopf, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; Pierre Goldbach, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; and Jonas L. Fast, Ph.D., is Group Leader, Early-Stage Pharmaceutical Development and GLP Tox Supplies, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd., Basel, Switzerland. Irene Krämer, Ph.D., is Director, Pharmacy Department, Medical Center of Johannes Gutenberg-University Hospital, Mainz, Germany, and Professor of Clinical Pharmacy, Pharmacy School of Johannes Gutenberg-University, Mainz. Hanns-Christian Mahler, Ph.D., is Head, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd
| | - Mary Cromwell
- Margaret Speed Ricci, Ph.D., is Director of Process Development, Drug Product Development, Genentech, South San Francisco, CA. Michelle Frazier, M.S., is Director, Regulatory Affairs, Amgen, Thousand Oaks, CA. Jamie Moore, Ph.D., is Director, Early-Stage Pharmaceutical Development; Mary Cromwell, Ph.D., is Director, Late-Stage Pharmaceutical Development; William J. Galush, Ph.D., is Scientist, Late-Stage Pharmaceutical Development; and Ankit R. Patel, Ph.D., is Scientist, Early-Stage Pharmaceutical Development, Pharmaceutical Development, Pharma Technical Development Biologics U.S., Genentech, South San Francisco, CA. Michael Adler, Ph.D., is Head, Late-Stage Pharmaceutical and Processing Development; Ulrike Altenburger, Ph.D., is Head, Early-Stage Pharmaceutical Development and GLP Tox Supplies; Ulla Grauschopf, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; Pierre Goldbach, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; and Jonas L. Fast, Ph.D., is Group Leader, Early-Stage Pharmaceutical Development and GLP Tox Supplies, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd., Basel, Switzerland. Irene Krämer, Ph.D., is Director, Pharmacy Department, Medical Center of Johannes Gutenberg-University Hospital, Mainz, Germany, and Professor of Clinical Pharmacy, Pharmacy School of Johannes Gutenberg-University, Mainz. Hanns-Christian Mahler, Ph.D., is Head, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd
| | - William J Galush
- Margaret Speed Ricci, Ph.D., is Director of Process Development, Drug Product Development, Genentech, South San Francisco, CA. Michelle Frazier, M.S., is Director, Regulatory Affairs, Amgen, Thousand Oaks, CA. Jamie Moore, Ph.D., is Director, Early-Stage Pharmaceutical Development; Mary Cromwell, Ph.D., is Director, Late-Stage Pharmaceutical Development; William J. Galush, Ph.D., is Scientist, Late-Stage Pharmaceutical Development; and Ankit R. Patel, Ph.D., is Scientist, Early-Stage Pharmaceutical Development, Pharmaceutical Development, Pharma Technical Development Biologics U.S., Genentech, South San Francisco, CA. Michael Adler, Ph.D., is Head, Late-Stage Pharmaceutical and Processing Development; Ulrike Altenburger, Ph.D., is Head, Early-Stage Pharmaceutical Development and GLP Tox Supplies; Ulla Grauschopf, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; Pierre Goldbach, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; and Jonas L. Fast, Ph.D., is Group Leader, Early-Stage Pharmaceutical Development and GLP Tox Supplies, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd., Basel, Switzerland. Irene Krämer, Ph.D., is Director, Pharmacy Department, Medical Center of Johannes Gutenberg-University Hospital, Mainz, Germany, and Professor of Clinical Pharmacy, Pharmacy School of Johannes Gutenberg-University, Mainz. Hanns-Christian Mahler, Ph.D., is Head, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd
| | - Ankit R Patel
- Margaret Speed Ricci, Ph.D., is Director of Process Development, Drug Product Development, Genentech, South San Francisco, CA. Michelle Frazier, M.S., is Director, Regulatory Affairs, Amgen, Thousand Oaks, CA. Jamie Moore, Ph.D., is Director, Early-Stage Pharmaceutical Development; Mary Cromwell, Ph.D., is Director, Late-Stage Pharmaceutical Development; William J. Galush, Ph.D., is Scientist, Late-Stage Pharmaceutical Development; and Ankit R. Patel, Ph.D., is Scientist, Early-Stage Pharmaceutical Development, Pharmaceutical Development, Pharma Technical Development Biologics U.S., Genentech, South San Francisco, CA. Michael Adler, Ph.D., is Head, Late-Stage Pharmaceutical and Processing Development; Ulrike Altenburger, Ph.D., is Head, Early-Stage Pharmaceutical Development and GLP Tox Supplies; Ulla Grauschopf, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; Pierre Goldbach, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; and Jonas L. Fast, Ph.D., is Group Leader, Early-Stage Pharmaceutical Development and GLP Tox Supplies, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd., Basel, Switzerland. Irene Krämer, Ph.D., is Director, Pharmacy Department, Medical Center of Johannes Gutenberg-University Hospital, Mainz, Germany, and Professor of Clinical Pharmacy, Pharmacy School of Johannes Gutenberg-University, Mainz. Hanns-Christian Mahler, Ph.D., is Head, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd
| | - Michael Adler
- Margaret Speed Ricci, Ph.D., is Director of Process Development, Drug Product Development, Genentech, South San Francisco, CA. Michelle Frazier, M.S., is Director, Regulatory Affairs, Amgen, Thousand Oaks, CA. Jamie Moore, Ph.D., is Director, Early-Stage Pharmaceutical Development; Mary Cromwell, Ph.D., is Director, Late-Stage Pharmaceutical Development; William J. Galush, Ph.D., is Scientist, Late-Stage Pharmaceutical Development; and Ankit R. Patel, Ph.D., is Scientist, Early-Stage Pharmaceutical Development, Pharmaceutical Development, Pharma Technical Development Biologics U.S., Genentech, South San Francisco, CA. Michael Adler, Ph.D., is Head, Late-Stage Pharmaceutical and Processing Development; Ulrike Altenburger, Ph.D., is Head, Early-Stage Pharmaceutical Development and GLP Tox Supplies; Ulla Grauschopf, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; Pierre Goldbach, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; and Jonas L. Fast, Ph.D., is Group Leader, Early-Stage Pharmaceutical Development and GLP Tox Supplies, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd., Basel, Switzerland. Irene Krämer, Ph.D., is Director, Pharmacy Department, Medical Center of Johannes Gutenberg-University Hospital, Mainz, Germany, and Professor of Clinical Pharmacy, Pharmacy School of Johannes Gutenberg-University, Mainz. Hanns-Christian Mahler, Ph.D., is Head, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd
| | - Ulrike Altenburger
- Margaret Speed Ricci, Ph.D., is Director of Process Development, Drug Product Development, Genentech, South San Francisco, CA. Michelle Frazier, M.S., is Director, Regulatory Affairs, Amgen, Thousand Oaks, CA. Jamie Moore, Ph.D., is Director, Early-Stage Pharmaceutical Development; Mary Cromwell, Ph.D., is Director, Late-Stage Pharmaceutical Development; William J. Galush, Ph.D., is Scientist, Late-Stage Pharmaceutical Development; and Ankit R. Patel, Ph.D., is Scientist, Early-Stage Pharmaceutical Development, Pharmaceutical Development, Pharma Technical Development Biologics U.S., Genentech, South San Francisco, CA. Michael Adler, Ph.D., is Head, Late-Stage Pharmaceutical and Processing Development; Ulrike Altenburger, Ph.D., is Head, Early-Stage Pharmaceutical Development and GLP Tox Supplies; Ulla Grauschopf, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; Pierre Goldbach, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; and Jonas L. Fast, Ph.D., is Group Leader, Early-Stage Pharmaceutical Development and GLP Tox Supplies, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd., Basel, Switzerland. Irene Krämer, Ph.D., is Director, Pharmacy Department, Medical Center of Johannes Gutenberg-University Hospital, Mainz, Germany, and Professor of Clinical Pharmacy, Pharmacy School of Johannes Gutenberg-University, Mainz. Hanns-Christian Mahler, Ph.D., is Head, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd
| | - Ulla Grauschopf
- Margaret Speed Ricci, Ph.D., is Director of Process Development, Drug Product Development, Genentech, South San Francisco, CA. Michelle Frazier, M.S., is Director, Regulatory Affairs, Amgen, Thousand Oaks, CA. Jamie Moore, Ph.D., is Director, Early-Stage Pharmaceutical Development; Mary Cromwell, Ph.D., is Director, Late-Stage Pharmaceutical Development; William J. Galush, Ph.D., is Scientist, Late-Stage Pharmaceutical Development; and Ankit R. Patel, Ph.D., is Scientist, Early-Stage Pharmaceutical Development, Pharmaceutical Development, Pharma Technical Development Biologics U.S., Genentech, South San Francisco, CA. Michael Adler, Ph.D., is Head, Late-Stage Pharmaceutical and Processing Development; Ulrike Altenburger, Ph.D., is Head, Early-Stage Pharmaceutical Development and GLP Tox Supplies; Ulla Grauschopf, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; Pierre Goldbach, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; and Jonas L. Fast, Ph.D., is Group Leader, Early-Stage Pharmaceutical Development and GLP Tox Supplies, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd., Basel, Switzerland. Irene Krämer, Ph.D., is Director, Pharmacy Department, Medical Center of Johannes Gutenberg-University Hospital, Mainz, Germany, and Professor of Clinical Pharmacy, Pharmacy School of Johannes Gutenberg-University, Mainz. Hanns-Christian Mahler, Ph.D., is Head, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd
| | - Pierre Goldbach
- Margaret Speed Ricci, Ph.D., is Director of Process Development, Drug Product Development, Genentech, South San Francisco, CA. Michelle Frazier, M.S., is Director, Regulatory Affairs, Amgen, Thousand Oaks, CA. Jamie Moore, Ph.D., is Director, Early-Stage Pharmaceutical Development; Mary Cromwell, Ph.D., is Director, Late-Stage Pharmaceutical Development; William J. Galush, Ph.D., is Scientist, Late-Stage Pharmaceutical Development; and Ankit R. Patel, Ph.D., is Scientist, Early-Stage Pharmaceutical Development, Pharmaceutical Development, Pharma Technical Development Biologics U.S., Genentech, South San Francisco, CA. Michael Adler, Ph.D., is Head, Late-Stage Pharmaceutical and Processing Development; Ulrike Altenburger, Ph.D., is Head, Early-Stage Pharmaceutical Development and GLP Tox Supplies; Ulla Grauschopf, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; Pierre Goldbach, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; and Jonas L. Fast, Ph.D., is Group Leader, Early-Stage Pharmaceutical Development and GLP Tox Supplies, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd., Basel, Switzerland. Irene Krämer, Ph.D., is Director, Pharmacy Department, Medical Center of Johannes Gutenberg-University Hospital, Mainz, Germany, and Professor of Clinical Pharmacy, Pharmacy School of Johannes Gutenberg-University, Mainz. Hanns-Christian Mahler, Ph.D., is Head, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd
| | - Jonas L Fast
- Margaret Speed Ricci, Ph.D., is Director of Process Development, Drug Product Development, Genentech, South San Francisco, CA. Michelle Frazier, M.S., is Director, Regulatory Affairs, Amgen, Thousand Oaks, CA. Jamie Moore, Ph.D., is Director, Early-Stage Pharmaceutical Development; Mary Cromwell, Ph.D., is Director, Late-Stage Pharmaceutical Development; William J. Galush, Ph.D., is Scientist, Late-Stage Pharmaceutical Development; and Ankit R. Patel, Ph.D., is Scientist, Early-Stage Pharmaceutical Development, Pharmaceutical Development, Pharma Technical Development Biologics U.S., Genentech, South San Francisco, CA. Michael Adler, Ph.D., is Head, Late-Stage Pharmaceutical and Processing Development; Ulrike Altenburger, Ph.D., is Head, Early-Stage Pharmaceutical Development and GLP Tox Supplies; Ulla Grauschopf, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; Pierre Goldbach, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; and Jonas L. Fast, Ph.D., is Group Leader, Early-Stage Pharmaceutical Development and GLP Tox Supplies, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd., Basel, Switzerland. Irene Krämer, Ph.D., is Director, Pharmacy Department, Medical Center of Johannes Gutenberg-University Hospital, Mainz, Germany, and Professor of Clinical Pharmacy, Pharmacy School of Johannes Gutenberg-University, Mainz. Hanns-Christian Mahler, Ph.D., is Head, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd
| | - Irene Krämer
- Margaret Speed Ricci, Ph.D., is Director of Process Development, Drug Product Development, Genentech, South San Francisco, CA. Michelle Frazier, M.S., is Director, Regulatory Affairs, Amgen, Thousand Oaks, CA. Jamie Moore, Ph.D., is Director, Early-Stage Pharmaceutical Development; Mary Cromwell, Ph.D., is Director, Late-Stage Pharmaceutical Development; William J. Galush, Ph.D., is Scientist, Late-Stage Pharmaceutical Development; and Ankit R. Patel, Ph.D., is Scientist, Early-Stage Pharmaceutical Development, Pharmaceutical Development, Pharma Technical Development Biologics U.S., Genentech, South San Francisco, CA. Michael Adler, Ph.D., is Head, Late-Stage Pharmaceutical and Processing Development; Ulrike Altenburger, Ph.D., is Head, Early-Stage Pharmaceutical Development and GLP Tox Supplies; Ulla Grauschopf, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; Pierre Goldbach, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; and Jonas L. Fast, Ph.D., is Group Leader, Early-Stage Pharmaceutical Development and GLP Tox Supplies, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd., Basel, Switzerland. Irene Krämer, Ph.D., is Director, Pharmacy Department, Medical Center of Johannes Gutenberg-University Hospital, Mainz, Germany, and Professor of Clinical Pharmacy, Pharmacy School of Johannes Gutenberg-University, Mainz. Hanns-Christian Mahler, Ph.D., is Head, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd
| | - Hanns-Christian Mahler
- Margaret Speed Ricci, Ph.D., is Director of Process Development, Drug Product Development, Genentech, South San Francisco, CA. Michelle Frazier, M.S., is Director, Regulatory Affairs, Amgen, Thousand Oaks, CA. Jamie Moore, Ph.D., is Director, Early-Stage Pharmaceutical Development; Mary Cromwell, Ph.D., is Director, Late-Stage Pharmaceutical Development; William J. Galush, Ph.D., is Scientist, Late-Stage Pharmaceutical Development; and Ankit R. Patel, Ph.D., is Scientist, Early-Stage Pharmaceutical Development, Pharmaceutical Development, Pharma Technical Development Biologics U.S., Genentech, South San Francisco, CA. Michael Adler, Ph.D., is Head, Late-Stage Pharmaceutical and Processing Development; Ulrike Altenburger, Ph.D., is Head, Early-Stage Pharmaceutical Development and GLP Tox Supplies; Ulla Grauschopf, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; Pierre Goldbach, Ph.D., is Senior Group Leader, Late-Stage Pharmaceutical and Processing Development; and Jonas L. Fast, Ph.D., is Group Leader, Early-Stage Pharmaceutical Development and GLP Tox Supplies, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd., Basel, Switzerland. Irene Krämer, Ph.D., is Director, Pharmacy Department, Medical Center of Johannes Gutenberg-University Hospital, Mainz, Germany, and Professor of Clinical Pharmacy, Pharmacy School of Johannes Gutenberg-University, Mainz. Hanns-Christian Mahler, Ph.D., is Head, Pharmaceutical Development and Supplies, Pharma Technical Development Biologics EU, F. Hoffmann-LaRoche Ltd.
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Madle M, Krämer I, Lehners N, Schwarzbich M, Wuchter P, Herfarth K, Egerer G, Ho AD, Witzens-Harig M. The influence of rituximab, high-dose therapy followed by autologous stem cell transplantation, and age in patients with primary CNS lymphoma. Ann Hematol 2015; 94:1853-7. [PMID: 26268792 DOI: 10.1007/s00277-015-2470-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
For patients with diffuse large B cell lymphoma without the involvement of the CNS, the addition of rituximab to standard chemotherapy has significantly improved survival. In this single-center, retrospective analysis, a total of 81 primary CNS lymphoma (PCNSL) patients treated in our institution between 2000 and 2011 were included. Beside first-line chemotherapy with or without rituximab, we evaluated the impact of age (≤/>60 years), autologous stem cell transplantation (ASCT +/-), and other factors upon overall survival (OS) and progression-free survival (PFS). In patients treated with rituximab (n = 27), 3-year OS was 77.8 % (95 % confidence interval (CI) 62-93 %). In contrast, in patients treated without rituximab (n = 52), 3-year OS was only 39.9 % (CI 27-53 %, Fig. 1). The difference in OS was significant in the univariate (p = 0.002) as well as in the multivariate analysis (p = 0.049, hazard ratio (HR) = 0.248). Patients ≤60 years of age (n = 28) had a 3-year OS of 78.2 % (CI 63-94 %); in patients >60 years (n = 51), 3-year OS was 38.7 % (CI 25-52 %). Patients who received high-dose therapy and ASCT had a 3-year OS of 85.2 % (CI 72-99 %), and 65.1 % were alive up to the time of analysis (range 9-131 months). Without ASCT, median OS was only 16 months (CI 11-21) and 3-year OS was 35.2 % (CI 22-48 %). Age and ASCT were significantly associated with better OS in univariate (p = 0.002 and p < 0.001) as well in multivariate analysis (p = 0.004, HR = 0.023 and p = 0.001, HR = 0.014). Rituximab treatment, ASCT, and age are independent prognostic factors for OS in the first-line treatment of PCNSL.
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Affiliation(s)
- M Madle
- Department of Hematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - I Krämer
- Department of Hematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - N Lehners
- Department of Hematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - M Schwarzbich
- Department of Hematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - P Wuchter
- Department of Hematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - K Herfarth
- Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - G Egerer
- Department of Hematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - A D Ho
- Department of Hematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - M Witzens-Harig
- Department of Hematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Abstract
Purpose The aim of this study was to determine the loading efficiency, physico-chemical stability and release of epirubicin-loaded DC Bead™ (Biocompatibles UK Ltd, a BTG International group company) (bead size 70–150 µm (=DC Bead M1™) and 100–300 µm) after loading with epirubicin solution (2 mg/ml) or reconstituted powder formulation (25 mg/ml) and controlled storage. Methods DC Bead™ were loaded with 76 mg epirubicin solution (Epimedac™, Medac GmbH) or 75 mg epirubicin powder formulation (Farmorubicin™, Pharmacia Pfizer GmbH) per 2 ml of beads. Drug loading efficiency and stability were determined by measuring the epirubicin concentration in the excess solution after predetermined intervals (maximum 24 h) and different agitation conditions. Syringes with loaded beads were stored protected from light at room temperature. At predetermined intervals the beads were transferred into 200 ml phosphate buffered solution (pH 7.2) as elution medium and stirred automatically for 2 h not followed or followed by addition of 200 ml of 20% sodium chloride (=NaCl) solution and stirred for another 2 h to analyse the drug release and integrity of the epirubicin-loaded beads. Elution experiments were performed and samples taken periodically over a four-week period (day 0, 7, 14 and 28). A reversed-phase high-performance liquid chromatography assay with ultraviolet detection was utilized to analyse the concentration and purity of epirubicin. Results The loading procedure for DC Bead™ with epirubicin drug solutions resulted in a loading percentage of 95–99% within 6 h dependent on the bead size, epirubicin concentration in the loading solution and loading conditions. Loading levels remained stable and no epirubicin degradation products were observed over the period of 28 days, while the loaded beads were stored light protected at room temperature. Release of epirubicin into 200 ml phosphate buffered solution elution medium and additionally followed by release into the admixture with 200 ml 20% NaCl solution amounted to 5% and about 20% of the loaded epirubicin, respectively. Integrity of loaded epirubicin was proven over 28 days. Conclusions Epirubicin can be loaded into DC Bead™ of different sizes using the epirubicin powder formulation (25 mg/ml) or epirubicin injection concentrate (2 mg/ml). Physico-chemical stability is maintained over a period of at least 28 days when stored light protected at room temperature. Elution of epirubicin is dependent on the volume and cation exchange capacity of the elution medium.
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Affiliation(s)
- Kirsten C Spindeldreier
- Department of Pharmacy, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Judith Thiesen
- Department of Pharmacy, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Irene Krämer
- Department of Pharmacy, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
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Bloomfield S, Exner M, Flemming HC, Goroncy-Bermes P, Hartemann P, Heeg P, Ilschner C, Krämer I, Merkens W, Oltmanns P, Rotter M, Rutala WA, Sonntag HG, Trautmann M. Lesser-known or hidden reservoirs of infection and implications for adequate prevention strategies: Where to look and what to look for. GMS Hyg Infect Control 2015; 10:Doc04. [PMID: 25699227 PMCID: PMC4332272 DOI: 10.3205/dgkh000247] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In developing hygiene strategies, in recent years, the major focus has been on the hands as the key route of infection transmission. However, there is a multitude of lesser-known and underestimated reservoirs for microorganisms which are the triggering sources and vehicles for outbreaks or sporadic cases of infection. Among those are water reservoirs such as sink drains, fixtures, decorative water fountains and waste-water treatment plants, frequently touched textile surfaces such as private curtains in hospitals and laundry, but also transvaginal ultrasound probes, parenteral drug products, and disinfectant wipe dispensers. The review of outbreak reports also reveals Gram-negative and multiple-drug resistant microorganisms to have become an increasingly frequent and severe threat in medical settings. In some instances, the causative organisms are particularly difficult to identify because they are concealed in biofilms or in a state referred to as viable but nonculturable, which eludes conventional culture media-based detection methods. There is an enormous preventative potential in these insights, which has not been fully tapped. New and emerging pathogens, novel pathogen detection methods, and hidden reservoirs of infection should hence be given special consideration when designing the layout of buildings and medical devices, but also when defining the core competencies for medical staff, establishing programmes for patient empowerment and education of the general public, and when implementing protocols for the prevention and control of infections in medical, community and domestic settings.
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Affiliation(s)
- Sally Bloomfield
- London School of Hygiene and Tropical Medicine, International Scientific Forum on Home Hygiene, London, UK
| | - Martin Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | | | - Philippe Hartemann
- Departement Environment et Santé Publique S.E.R.E.S., Faculté de Médicine, Nancy, France
| | - Peter Heeg
- Institute of Medical Microbiology and Hygiene, Tübingen, Germany
| | - Carola Ilschner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - Irene Krämer
- Pharmacy Department of Mainz University, Mainz, Germany
| | | | | | | | | | | | - Matthias Trautmann
- Department of Hospital Hygiene at Stuttgart Hospital, Stuttgart, Germany
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Riedl M, Kolbe E, Kampmann E, Krämer I, Kahaly GJ. Prospectively recorded and MedDRA-coded safety data of intravenous methylprednisolone therapy in Graves' orbitopathy. J Endocrinol Invest 2015; 38:177-82. [PMID: 25576458 DOI: 10.1007/s40618-014-0227-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
Abstract
CONTEXT Safety of intravenous (IV) steroid pulses in patients with Graves' orbitopathy (GO) is still controversial while steroid dose and treatment application have not been finalized. Frequency, severity and characterization of adverse events (AE) were prospectively analyzed. SETTING Academic referral orbital center with a joint thyroid-eye clinic. PATIENTS Eighty consecutive and unselected patients with active and severe GO. METHODS During an established treatment with IV methylprednisolone (cumulative dose 4.5 g) occurring AE were prospectively coded according to the standardized and recognized medical dictionary for regulatory activities (MedDRA). Outcome and severity of AE were documented. AEs judged as at least possibly related to drug treatment were graded as side effect (SE). AEs matching a seriousness criteria as defined by the ICH guideline E6 (good clinical practice) were graded as serious. RESULTS A total of 38.75% (31/80) of the treated GO patients reported at least one AE while 18 patients (22.5%) reported at least one SE. All SE were within the safety profile of IV methylprednisolone; 31/32 SE (96.87%) were mild-moderate and reversible and only 1/80 patient (1.25%) stopped steroid treatment due to exacerbation of her depression. Most AE were accessory symptoms of the underlying disease and a few only were directly related to IV steroids. Most AEs (90.6%) were graded as mild. Only six patients (7.5%) were hospitalized, three of them due to a dysthyroid optic neuropathy. CONCLUSIONS Prospective and standardized evaluation with MedDRA and the ICH guideline demonstrated the good pharmacological tolerance and low morbidity of this moderate steroid regimen.
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Affiliation(s)
- M Riedl
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
- Interdisciplinary Center for Clinical Trials, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - E Kolbe
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - E Kampmann
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - I Krämer
- Central Pharmacy, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - G J Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany.
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Spindeldreier KC, Thiesen J, Krämer I. Physicochemical stability of cabazitaxel containing premix solution and diluted infusion solutions. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2014-000563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Krämer I, Federici M, Kaiser V, Thiesen J. Media-fill simulation tests in manual and robotic aseptic preparation of injection solutions in syringes. J Oncol Pharm Pract 2014; 22:195-204. [PMID: 25549919 DOI: 10.1177/1078155214565123] [Citation(s) in RCA: 10] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the contamination rate of media-fill products either prepared automated with a robotic system (APOTECAchemo™) or prepared manually at cytotoxic workbenches in the same cleanroom environment and by experienced operators. Media fills were completed by microbiological environmental control in the critical zones and used to validate the cleaning and disinfection procedures of the robotic system. METHODS The aseptic preparation of patient individual ready-to-use injection solutions was simulated by using double concentrated tryptic soy broth as growth medium, water for injection and plastic syringes as primary packaging materials. Media fills were either prepared automated (500 units) in the robot or manually (500 units) in cytotoxic workbenches in the same cleanroom over a period of 18 working days. The test solutions were incubated at room temperature (22℃) over 4 weeks. Products were visually inspected for turbidity after a 2-week and 4-week period. Following incubation, growth promotion tests were performed with Staphylococcus epidermidis. During the media-fill procedures, passive air monitoring was performed with settle plates and surface monitoring with contact plates on predefined locations as well as fingerprints. The plates got incubated for 5-7 days at room temperature, followed by 2-3 days at 30-35℃ and the colony forming units (cfu) counted after both periods. The robot was cleaned and disinfected according to the established standard operating procedure on two working days prior to the media-fill session, while on six other working days only six critical components were sanitized at the end of the media-fill sessions. Every day UV irradiation was operated for 4 h after finishing work. RESULTS None of the 1000 media-fill products prepared in the two different settings showed turbidity after the incubation period thereby indicating no contamination with microorganisms. All products remained uniform, clear, and light-amber solutions. In addition, the reliability of the nutrient medium and the process was demonstrated by positive growth promotion tests with S. epidermidis. During automated preparation the recommended limits < 1 cfu per settle/contact plate set for cleanroom Grade A zones were not succeeded in the carousel and working area, but in the loading area of the robot. During manual preparation, the number of cfus detected on settle/contact plates inside the workbenches lay far below the limits. The number of cfus detected on fingertips succeeded several times the limit during manual preparation but not during automated preparation. There was no difference in the microbial contamination rate depending on the extent of cleaning and disinfection of the robot. CONCLUSION Extensive media-fill tests simulating manual and automated preparation of ready-to-use cytotoxic injection solutions revealed the same level of sterility for both procedures. The results of supplemental environmental controls confirmed that the aseptic procedures are well controlled. As there was no difference in the microbial contamination rates of the media preparations depending on the extent of cleaning and disinfection of the robot, the results were used to adapt the respective standard operating procedures.
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Affiliation(s)
- Irene Krämer
- Department of Pharmacy, University Medical Center, Johannes Gutenberg-University, Langenbeckstraße 1, Mainz, Germany
| | - Matteo Federici
- Department of Pharmacy, University Medical Center, Johannes Gutenberg-University, Langenbeckstraße 1, Mainz, Germany
| | - Vanessa Kaiser
- Department of Pharmacy, University Medical Center, Johannes Gutenberg-University, Langenbeckstraße 1, Mainz, Germany
| | - Judith Thiesen
- Department of Pharmacy, University Medical Center, Johannes Gutenberg-University, Langenbeckstraße 1, Mainz, Germany
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Kamin W, Erdnüss F, Krämer I. Inhalation solutions — Which ones may be mixed? Physico-chemical compatibility of drug solutions in nebulizers — Update 2013. J Cyst Fibros 2014; 13:243-50. [DOI: 10.1016/j.jcf.2013.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 09/16/2013] [Accepted: 09/20/2013] [Indexed: 12/13/2022]
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Spindeldreier KC, Krämer I. PP-033 Physico-chemical stability of cabazitaxel-containing premix solution and ready-to-administer solutions. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000436.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Walz-Jung H, Krämer I, Kamin W. In-vitro-Vergleich der Aerosolqualität von sieben Verneblergeräten mittels zwei Simulationsmodellen. Pneumologie 2014. [DOI: 10.1055/s-0034-1367749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Krämer I. Denosumab (XGEVA): assessment from a pharmacist's perspective. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Klemmer A, Krämer I, Kamin W. Physicochemical compatibility and stability of nebulizable drug admixtures containing Dornase alfa and tobramycin. Pulm Pharmacol Ther 2013; 28:53-59. [PMID: 24035821 DOI: 10.1016/j.pupt.2013.08.003] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 08/03/2013] [Accepted: 08/29/2013] [Indexed: 10/26/2022]
Abstract
The objective of this in-vitro study was to determine whether admixtures of the inhalation solutions Pulmozyme(®) (Dornase alfa) and either Bramitob(®) or Tobi(®) (both containing Tobramycin) are physicochemically compatible and to analyze the aerodynamic parameters of these admixtures. After mixing, test solutions were stored at room temperature and under ambient light conditions over a period of 24 h. Tobramycin concentrations were determined by using a fluorescence immunoassay. Stability of dornase alfa was determined by size-exclusion high performance liquid chromatography, ultraviolet spectroscopy, sodium dodecyl sulfate polyacrylamide gel electrophoresis and tentacle strong cation-exchange chromatography. In addition, pH values and osmolality of the admixtures were measured and test solutions were visually examined for any changes up to 24 h. Aerosols of Pulmozyme(®)/Bramitob(®) or Pulmozyme(®)/TOBI(®) admixtures were generated with the PARI eFlow(®) rapid and aerodynamic particle sizing was performed via cascade impaction with the Next Generation Pharmaceutical Impactor. The stability tests revealed that neither the stability of tobramycin nor the stability of dornase alfa was affected by mixing the inhalation products. Cascade impaction showed no relevant changes in particle size distribution, Mass Median Aerodynamic Diameter, Geometric Standard Deviation and Fine Particle Fraction in comparison to aerodynamic parameters of the unmixed solutions. Thus, admixtures of Pulmozyme(®) and either Bramitob(®) or TOBI(®) can be designated as compatible for a 24 h period and simultaneous inhalation is feasible.
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Affiliation(s)
- Anja Klemmer
- Department of Pharmacy of the University Medical Center, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Irene Krämer
- Department of Pharmacy of the University Medical Center, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany.
| | - Wolfgang Kamin
- Pediatric Department, Lutherian Hospital Hamm, Werler Str. 130, 59063 Hamm, Germany
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Wollstadt A, Krämer I, Kamin W. Physicochemical compatibility of nebulizable drug admixtures containing colistimethate and tobramycin. Pharmazie 2013; 68:744-748. [PMID: 24147342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Inhalation therapy with nebulizable antibiotic drugs is a mainstay in treating Pseudomonas aeruginosa infections in cystic fibrosis patients. The combination of tobramycin and colistin was found to be superior to monotherapy in killing P. aeruginosa in biofilms. The simultaneous inhalation of tobramycin and colistin might be an option to increase the compliance of patients. The objective of this in-vitro study was to determine whether admixtures of inhalation solutions containing colistin methanesulfonate (CMS) and tobramycin are physicochemically compatible. Physical compatibility was determined by measuring pH and osmolality. Chemical compatibility was determined by testing the antibiotic activity of the mixtures by the pharmacopoeial microbiological assay and comparing the results to those of standard solutions. Samples were analyzed immediately after mixing and after 24 h. Values of pH and osmolality remained unchanged and in physiologically acceptable ranges. Neither for colistin methanesulfonate (CMS) nor for tobramycin losses of antibiotic potency were registered at any time. Admixtures of nebulizer solutions containing CMS and tobramycin were shown to be physicochemically compatible. Further investigations are needed to determine whether drug delivery is affected by mixing the nebulizer solutions to ensure that simultaneous inhalation is recommendable.
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Affiliation(s)
- A Wollstadt
- Department of Pharmacy, Johannes Gutenberg-University Medical Center, Mainz, Germany
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Spindeldreier K, Thiesen J, Lipp HP, Krämer I. Physico-chemical stability of eribulin mesylate containing concentrate and ready-to-administer solutions. J Oncol Pharm Pract 2013; 20:183-9. [PMID: 23812666 DOI: 10.1177/1078155213492449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to determine the stability of commercially available eribulin mesylate containing injection solution as well as diluted ready-to-administer solutions stored under refrigeration or at room temperature. METHODS Stability was studied by a novel developed stability-indicating reversed-phase high-performance liquid chromatography (RP-HPLC) assay with ultraviolet detection (detection wavelength 200 nm). Triplicate test solutions of eribulin mesylate containing injection concentrate (0.5 mg/mL) and with 0.9% sodium chloride solution diluted ready-to-administer preparations (0.205 mg/mL eribulin mesylate in polypropylene (PP) syringes, 0.020 mg/mL eribulin mesylate in polypropylene/polyethylene (PE) bags) were stored protected from light either at room temperature (25) or under refrigeration (2-8). Samples were withdrawn on day 0 (initial), 1, 3, 5, 7, 14, 21 and 28 of storage and assayed. Physical stability was determined by measuring the pH value once a week and checking for visible precipitations or colour changes. RESULTS The stability tests revealed that concentrations of eribulin mesylate remained unchanged over a period of 28 days irrespective of concentration, container material or storage temperature. Neither colour changes nor visible particles have been observed. The pH value varied slightly over time but remained in the stability favourable range of 5-9. CONCLUSION Eribulin mesylate injection (0.5 mg/mL) is physico-chemically stable over a period of 28 days after first puncture of the vial. After dilution with 0.9% NaCl vehicle solution, ready-to-administer eribulin mesylate injection solutions (0.205 mg/mL in PP syringe) and infusion solutions (0.02 mg/mL in prefilled PP/PE bags) are physico-chemically stable for a period of at least four weeks either refrigerated or stored at room temperature. For microbiological reasons storage under refrigeration is recommended.
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Affiliation(s)
- Kirsten Spindeldreier
- Department of Pharmacy, University Medical Center Mainz, Johannes Gutenberg-University, Germany
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Eberlin M, Otto G, Krämer I. Increased medication compliance of liver transplant patients switched from a twice-daily to a once-daily tacrolimus-based immunosuppressive regimen. Transplant Proc 2013; 45:2314-20. [PMID: 23726723 DOI: 10.1016/j.transproceed.2012.10.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/09/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND Compliance with immunosuppressive therapy plays a major role in the long-term success of liver transplantation. Thus, the development of strategies to promote compliance of liver transplant patients and its evaluation over time are of particular interest. OBJECTIVE The main objective of this study was to compare medication compliance rates among liver transplant patients over time after transplantation where switched from a twice- to once-daily tacrolimus-based regimen. METHODS Sixty-five liver transplant patients being administered tacrolimus-based therapy were classified into three subgroups with regard to time posttransplantation. Medication compliance with tacrolimus-based therapy was measured using an electronic medication event monitoring system over a 12-month period: for 6 months tacrolimus was administered twice-daily and for 6 months, once-daily. Dosing, taking, and timing compliance as well as drug holidays were compared intra-individually between twice- and once-daily intake and among the three subgroups. In addition, patient compliance and quality of life were evaluated using questionnaires. RESULTS A per protocol analysis of electronically obtained data showed 63 patients to be eligible. The resulting dosing, taking, and timing compliance rates of the patients were higher during the once-daily dosing period. No significant differences in compliance rates with tacrolimus therapy were observed among three subgroups independent of the dosing regimen. More patients failed the correct timing of the evening compared to the morning dose. Missing doses occurred particularly during weekends. Compliance variables measured by questionnaires (Morisky score, self-report, Medication Experience Scale for Immunosuppressants (MESI) score) and the Hospital Anxiety and Depression Scale score were similar in the two dosing periods. The short-form health survey (SF-36) score was higher with once-daily intake. CONCLUSION The high measured compliance rates did not vary significantly dependent upon the time after transplantation. Nevertheless, compliance rates were greater using once-daily tacrolimus dosing.
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Affiliation(s)
- M Eberlin
- Department of Pharmacy, University Medical Center, Mainz, Germany.
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