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The most exciting
products I have been formulating are the trouches.
These are sublingual tablets that dissolve under the tongue, with
an onset of action within 3 minutes.
Some medications
that I have been making into this dose form include Viagra, and
many natural occurring hormones (DHEA, progesterone, testosterone,
oestriol, oestrone, oestradiol).
These have been shown to be extremely effective because patients
are actually administering the hormones produced in the body,
not a derivative or analogue of a hormone.
Doses are determined by a patient taking a full blood count (obviously
including hormone levels).
So far, this medication has been effective in helping emotional
instability, depression, and related conditions.
The effect has not been instant, with hormone levels re-adjusting
after the first few weeks of dosing, then a plateau into therapeutic
ranges.
The trouches are quite easy to make, and typically takes around
one hour to produce 30 tablets.
The base used is polyglycol, which is melted down and the active
ingredients are sieved, then dissolved into the base.
Flavouring is also added (depending on the patient’s liking).
Counseling is necessary to inform patients that the tablet can
not be swallowed, and time must be allowed for buccal absorption.
Some of the
hormone preparations have been made into a cream, which has been
shown to be more effective and easy to use for some patients.
Personally, I prefer the trouches because I believe it is more
likely that the patient will use the medication, and take the
right amount.
There is some concern to how much of the cream a patient will
be applying to their body (the cream should be placed on a non-hairy
part of the body.
For preparations such as progesterone, it is recommended that
the cream be applied to fatty tissue because if the ovaries are
producing a low level of progesterone, the other major production
site is fatty tissue.
Supplying progesterone to fatty tissue may stimulate its production).
Another dose
form that I have mentioned in a previous article that I now have
been formulating is capsules. This is also done for various hormone
products (including thyroid preparations), as well as dexamphetamine
and methylphenidate.
The pharmacy I am working at has been making such capsules for
around nine months, and now there has been the release of Ritalin
LA, a long acting capsule of methylphenidate.
This has high potential for revolutionising treatment of ADD for
students at school, increasing compliance.
The advantages of this product over the formulated capsules at
the pharmacy are, that they have a faster onset of action with
a similar duration of action.
The pediatrician that works within the medical centre of my workplace
is looking at transferring most of his patients to the Ritalin
LA, but has one concern with the new product.
The duration of action is eight hours, which is not quite long
enough for a once a day dosing. This has forced the pediatrician
to give an evening dose of the regular Ritalin also (which is
still a lot more convenient and cost effective for the patient).
Another issue with prescribing is that if a specialist wants a
patient to now also take the Ritalin LA, the original script for
Ritalin must be cancelled.
The doctor can then write a new script for Ritalin LA, and Ritalin
(but the scripts for both items must be written together).
This is causing some management concerns.
From my experiences
already in the pharmacy profession, I have witnessed huge changes
in the way many drugs can be formulated to improve a patient’s
quality of life.
I find it enthralling to think how such conditions such as ADD
will be treated in the future.
I am proud to see that the old skills that pharmacists have been
taught for centuries still have a framework to allow pharmacists
of today to develop drugs in virtually any form the doctor desires,
if they believe it will be beneficial to the patient.
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