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Tablet Splitting of a Narrow Therapeutic Index Drug: A Case with Levothyroxine Sodium

机译:窄治疗指数药物的片剂分裂:左甲状腺素钠一例

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摘要

Levothyroxine is a narrow therapeutic index, and to avoid adverse effect associated with under or excessive dosage, the dose response is carefully titrated. The tablets are marketed with a score providing an option to split. However, there are no systematic studies evaluating the effect of splitting on dose accuracy, and current study was undertaken to evaluate effects of splitting and potential causes for uniformity failures by measuring assay and content uniformity in whole and split tablets. Stability was evaluated by assaying drug for a period of 8 weeks. Effect of formulation factors on splittability was evaluated by a systematic investigation of formulation factors by preparing levothyroxine tablets in house by varying the type of excipients (binder, diluent, disintegrant, glidant) or by varying the processing factors (granulating liquid, mixing type, compression pressure). The tablets were analyzed using novel analytical tool such as near infrared chemical imaging to visualize the distribution of levothyroxine. Assay was not significantly different for whole versus split tablets irrespective of method of splitting (hand or splitter), and splitting also had no measurable impact on the stability. Split tablets either by hand or splitter showed higher rate of content uniformity failures as compared to whole tablets. Tablet splitter produced more fragmentation and, hence, more content uniformity and friability failures. Chemical imaging data revealed that the distribution of levothyroxine was heterogeneous and was dependent on type of binder and the process used in the manufacture of tablets. Splitting such tablets could prove detrimental if sub- or super-potency becomes an issue.
机译:左甲状腺素是一个狭窄的治疗指标,为避免与剂量不足或过量有关的不良反应,应仔细调整剂量反应。平板电脑上销售的分数提供了拆分选项。然而,目前尚无系统的研究来评估分裂对剂量准确度的影响,目前正在进行的研究是通过测量整片和分裂片剂的含量和均一性来评估分裂的影响和均一性失败的潜在原因。通过测定药物8周的时间来评估稳定性。通过系统地研究配方因素来评估配方因素对可拆分性的影响,方法是通过改变赋形剂的类型(粘合剂,稀释剂,崩解剂,助流剂)或通过改变加工因素(制粒液体,混合类型,压片)在家中制备左甲状腺素片压力)。使用新型分析工具(如近红外化学成像)对片剂进行分析,以可视化左甲状腺素的分布。不论分割方法(手工或分割器)如何,整片和分割片的测定均无显着差异,并且分割对稳定性也没有可测量的影响。与整个片剂相比,通过手工或分离器进行的分裂片剂显示出更高的含量均匀性故障率。片剂分裂剂产生更多的碎裂,因此,更多的含量均匀性和脆碎性失败。化学成像数据表明,左甲状腺素的分布是不均匀的,并且取决于粘合剂的类型和片剂生产中使用的工艺。如果低效或超效成为一个问题,那么拆分这种药片可能会受到损害。

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