Višečestične formulacije lekova za oralnu primenu kao strategija za precizno doziranje kod pedijatrijskih pacijenata: studija slučaja propranolola
Sažetak
Razvoj čvrstih farmaceutskih oblika lekova koji su prikladni za primenu kod pedijatrijske populacije pacijenata, ali koji istovremeno omogućavaju i precizno doziranje lekovite supstance, predstavlja jedan od vodećih izazova u farmaceutskoj tehnologiji. Prikazana studija koristi propranolol-hidrohlorid, kao jedan od najčešće primenjivanih lekova koji zahteva prilagođavanje farmaceutskih oblika za primenu kod dece. Višečestični farmaceutski oblici u vidu kapsula napunjenih praškom ili granulama, kao i mini tablete, su izrađene i ispitane u pogledu variranja mase i ujednačenosti sadržaja lekovite supstance. Dobijeni rezultati su upoređeni sa variranjem mase uzoraka koji se dobijaju deljenjem konvencionalnih registrovanih tableta na polovine i četvrtine. Dobijeni rezultati ukazuju na superiornost višečestičnih farmaceutskih oblika, zbog visokog stepena ujednačenosti mase i sadržaja lekovite supstance. Takođe je pokazano da se, zbog unapređene protočnosti, kapsule lakše pune granulama u odnosu na praškove, kao i da takvi farmaceutski oblici imaju veću ujednačenost mase i sadržaja lekovite supstance. Predstavljeni postupak izrade je jednostavan za izvođenje u uslovima apoteke. Mini tablete sa visokim udelom i ujednačenim sadržajem propranolol-hidrohlorida su uspešno izrađene, i predstavljaju značajnu strategiju koja može da omogući efikasno prilagođavanje doze lekovite supstance.
Reference
Zajicek A, Fossler MJ, Barrett JS, Worthington JH, Ternik R, Charkoftaki G, et al. A report from the pediatric formulations task force: perspectives on the state of child-friendly oral dosage forms. AAPS J. 2013;15(4):1072-81.
Thabet Y, Klingmann V, Breitkreutz J. Drug formulations: Standards and novel strategies for drug administration in pediatrics. J Clin Pharmacol. 2018;58(S10):S26-S35.
Trofimiuk M, Wasilewska K, Winnicka K. How to modify drug release in paediatric dosage forms? Novel technologies and modern approaches with regard to children’s population. Int J Mol Sci. 2019;20(13):3200.
Galande AD, Khurana NA, Mutalik S. Pediatric dosage forms-challenges and recent developments: A critical review. J Appl Pharm Sci. 2020;10(07):155-66.
European Medicines Agency: EMA/CHMP/QWP/805880/2012 - Guideline on pharmaceutical development of medicines for paediatric use 2013 [Internet] [Cited 2020 April]. Available from: https://www.ema.europa.eu/en/documents/scientific-guideline/guidelinepharmaceutical-development-medicines-paediatric-use_en.pdf.
World Health Organization: QAS/08.257/Rev.3. Geneva, 2011. Annex 5: Development of paediatric medicines: points to consider in formulation [Internet] [Cited 2020 April]. Available from: https://www.who.int/medicines/areas/quality_safety/quality_assurance/Annex5TRS970.pdf?ua=1.
European Medicines Agency: EMEA/CHMP/PEG/194810/2005 - Reflection paper: Formulations of choice for the paediatric population 2006 [Internet] [Cited 2020 April]. Available from: https://www.ema.europa.eu/en/documents/scientific-guideline/reflection-paper-formulations-choice-paediatric-population_en.pdf.
European Medicines Agency: EMA/761434/2010 - Report on the survey of all paediatric uses of medicinal products in Europe: Executive summary 2011 [Internet] [Cited 2020 April]. Available from:https://www.ema.europa.eu/en/documents/other/report-survey-all-paediatric-usesmedicinal-products-europe-executive-summary_en.pdf.
Medicines.org.uk. 2020. Propranolol tablets 10 mg BP - Summary of Product Characteristics (SPC) - (Emc) [Internet] [Cited 2020 May 24]. Available from:
https://www.medicines.org.uk/emc/product/5888/smpc.
Alims.gov.rs 2020. Propranolol tablets 40 mg - Summary of Product Characteristics (SPC) - Medicines and Medical Devices Agency of the Republic of Serbia [Internet] [Cited 2020 July 24]. Available from: https://www.alims.gov.rs/ciril/files/lekovi/smpc/515-01-01419-17-001.pdf.
European Medicines Agency. Hemangiol 3.75 mg/ml oral solution - Summary of Product Characteristics (SPC). [Internet] [Cited 2020 May 24]. Available from:
https://www.ema.europa.eu/en/documents/product-information/hemangioleparproduct-information_en.pdf
Van Vooren L, De Spiegeleer B, Thonissen T, Joye P, Van Durme J, Slegers G. Statistical analysis of tablet breakability methods. J Pharm Pharmaceutic Sci. 2002;5(2):190-8.
Van Santen E, Barends DM, Frijlink HW. Breaking of scored tablets: a review. Eur J Pharm Biopharm. 2002;53(2):139-45.
Hill SW, Varker AS, Karlage K, Myrdal PB. Analysis of drug content and weight uniformity for half-tablets of 6 commonly split medications. J Manag Care Pharm. 2009;15(3):253-61.
Teng J, Song CK, Williams RL, Polli JE. Lack of medication dose uniformity in commonly split tablets. J Am Pharm Assoc (Wash). 2002;42(2):195-9.
Ranmal SR, Cram A, Tuleu C. Age-appropriate and acceptable paediatric dosage forms: Insights into end-user perceptions, preferences and practices from the Children’s Acceptability of Oral Formulations (CALF) Study. Int J Pharm. 2016;514(1):296–307.
Lee HS, Lee JJ, Kim MG, Kim KT, Cho CW, Kim DD, Lee JY. Sprinkle formulations - A review of commercially available product. Asian J Pharm Sci. 2020;15(3):292-310.
Stoltenberg I, Breitkreutz J. Orally disintegrating mini-tablets (ODMTs) - A novel solid oral dosage form for paediatric use. Eur J Pharm Biopharm. 2011;78(3):462–9.
Thomson SA, Tuleu C, Wong ICK, Keady S, Pitt KG, Sutcliffe AG. Minitablets: New modality to deliver medicines to preschool-aged children. Pediatrics. 2009;123(2):235-8.
Wening K, Breitkreutz J. Oral drug delivery in personalized medicine: Unmet needs and novel approaches. Int J Pharm. 2011;404(1–2):1–9.
Iyire A, Mohammed AR. Multiparticulate systems for paediatric drug delivery. In: Rajabi-Siahboomi AR. Multiparticulate Drug Delivery. New York: Springer; 2017; p. 213-36.
Desitin.de/produkte/orfiril-long/ 2020. Orfiril long 150 mg - Patient information leaflets (PIL) [Internet] Desitin Arzneimittel GmbH [Cited 2020 July 26]. Available https://www.desitin.de/wp-content/uploads/2019/08/Orfiril_long_150mg-300mg_GI.pdf.
Desitin.de/produkte/levetiracetam-desitin/ 2020. Levetiracetam DESITIN 250 mg - Patient information leaflets (PIL) [Internet] Desitin Arzneimittel GmbH [Cited 2020 July 26]. Available from: https://www.desitin.de/wpcontent/uploads/2019/09/Levetiracetam_Desitin_GI.pdf.
Enzym Lefax forte kapseln [Internet] [Cited 2020 July 26]. Available from:
https://www.medikamente-per-klick.de/images/ecommerce/02/56/02563871_2008
06_de_o.pdf.
European Pharmacopoeia (Ph. Eur.). 10th ed, Strasbourg: Council of Europe, 2020.
Bajcetic M, Jelisavcic M, Mitrovic J, Divac N, Simeunovic S, Samardzic R, Gorodischer R. Off label and unlicensed drugs use in paediatric cardiology. Eur J Clin Pharmacol. 2005;6:775–9.
Paul S, Chang SY, Dun J, Sun WJ; Wang K, Tajarobi P, et al. Comparative analyses of flow and compaction properties of diverse mannitol and lactose grades. Int J Pharm. 2018;546(1-2):39-49.
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