Cost-Effectiveness and Guidelines for Opioid Substitution Treatment

There was evidence indicating that in the treatment of opioid use disorder, injectable hydromorphone, or injectable methadone provided more benefit at less cost compared with injectable diacetylmorphine over a 6-month time horizon. Evidence suggests that in the treatment of opioid use disorder, both injectable hydromorphone and injectable diacetylmorphine are likely to provide more benefit at less cost than methadone maintenance treatment. Treatment with injectable hydromorphone was more cost-effective than injectable diacetylmorphine in opioid use disorder patients who do not respond to or relapse from drug treatments. The evidence is limited because observed data were collected during a short-term follow-up, and long-term cost-effectiveness outcomes were based on extrapolations beyond data from the actual studies. One guideline provided a weak recommendation, supported by low-quality evidence, for using slow-release oral morphine in older adults with adequate renal function in whom buprenorphine and methadone maintenance have been ineffective to treat opioid use disorder or could not be tolerated. Another guideline recommends using injectable hydromorphone or injectable diacetylmorphine for individuals with severe opioid use disorders who relapsed previous treatments failed. No relevant cost-effectiveness evidence or guidelines with recommendations regarding the use of oral hydromorphone, fentanyl patches, or fentanyl buccal tablets for opioid use disorder treatment were identified; therefore, no summary can be provided.

Formulation and Evaluation of Mucoadhesive Buccal Tablets of Anti-Diabetic Drug using 23 Factorial Design

The aim of the present study involved the formulation and evaluation of mucoadhesive buccal tablets of anti-diabetic drug gliclazide, Mucoadhesive buccal tablets of Gliclazide are prepared by direct compression method In this present investigational research work the mucoadhesive buccal tablets of gliclazide is prepared separately employing 23 randomized full factorial design by using xanthan gum, carbopol-934, HPMC-E15LV, In this experimental model, target is to determine how the t90% of drug release and mucoadhesive characters can be affected by adjusting three parameters, concentration of polymers xanthan gum, HPMC-E15LV, carbopol-934, of the mucoadhesive buccal tablets. 2 3 full factorial studies were designed to determine the interaction of three independent variables at two levels (low and high level concentration) The tablets were tested for weight variation, hardness, surface pH, drug content uniformity, swelling index, mucoadhesion strength and in-vitro drug release study, Ex- vivo mucoadhesion time. From the drug release studies it was found that formulation H4 containing has good drug release when compared to other formulations.

OPTIMASI FORMULA TABLET BUKAL MUKOADHESIVE GLIBENKLAMID MENGGUNAKAN MATRIKS CMC NA SERTA ASAM OLEAT SEBAGAI ENHANCHER

Glibenclamide is a sulfonylurea class of antidiabetic drugs that works by stimulating insulin secretion in the pancreas so that it is effective only when the β-cells of the pancreas can still produce. The glibenclamide dosage form that is on the market is a conventional oral tablet which has various disadvantages in terms of pharmacokinetics. Based on this, it is necessary to develop a more effective drug delivery system for glibenclamide in order to avoid first-pass metabolism so as to increase the bioavailability of glibenclamide, namely by making mucoadhesive buccal tablets. This glibenclamide mucoadhesive buccal tablet is formulated using a variety of mucoadhesive polymers, namely CMC Na and oleic acid as enhancers. The manufacture of four mucoadhesive buccal tablet formulas used the direct compression method. The results of the weight uniformity test showed that they did not meet the NP requirements specified, all formulas had an NP of more than 15. The tablet hardness test also showed results that did not meet the test requirements. However, the results of the physical properties of the brittleness, pH and swelling index showed the results that met the test requirements. In this research, the optimum variation of CMC Na polymer and oleic acid as enhancers to physical properties (hardness, brittleness, pH, swelling ability) and the release of glibenclamide mucoadhesive tablets were CMC Na of 37.5 mg and oleic acid of 3.5. ml.

DESIGN OF CONTROLLED RELEASE MUCOADHESIVE BUCCAL TABLETS OF IVABRADINE HCL USING SINTERING TECHNIQUE

Objective: The objective of the present work was to study the use of the sintering technique, a relatively new concept in pharmaceutical sciences, in the development of mucoadhesive buccal tablets for ivabradine Hydrochloride. Methods: The method consisted of blending drug, hydroxypropyl methylcellulose (HPMC K100M), carnauba wax, and other excipients followed by direct compression into tablets. The compressed fluffy matrices were sintered at two different constant temperatures like 50 °C and 60 °C for two different periods like 1.5 h and 3 h in a hot air oven. The effect of sintering on tensile strength, dissolution profile, and other parameters were studied. The drug-polymer-excipient compatibility was evaluated by Fourier transform Infrared (FTIR) and differential scanning calorimetric (DSC) studies. Results: The sintering condition markedly affected the drug release properties, hardness, and friability of the tablets. Based on the f2 similarity factor value, Ex-vivo mucoadhesive strength, Ex-vivo residence time, and in vitro dissolution studies, formulation F3SD was selected as an optimized formulation. Drug release followed a non-Fickian diffusion mechanism with the Higuchi model release kinetics. Stability studies of mucoadhesive buccal tablets in normal human saliva indicated the stability of the drug and buccal tablet in the oral cavity. Stability studies as per ICH guidelines revealed that optimized formulation was stable on storage conditions. Conclusion: The sintering technique provides a significant and convenient method for the development of a controlled release dosage form that can be used in the design of mucoadhesive buccal tablets of Ivabradine HCL.

Formulation and Characterization of Eplerenone Mucoadhesive Buccal Tablets

Mucoadhesive drug release system is a preferably unidirectional release system where mucosal epithelial exterior is enclosed by the mucus deposit that interacts with the bio-adhesive drug delivery system and swelling time of the buccal dosage form which is amplified by mucin molecules at the location of administration. Eplerenone is an Anti-hypertensive drug that undergoes hepatic first pass metabolism and shows 69% of bioavailability. In order to bypass the hepatic first pass metabolism the drug is designed to be delivered through buccal cavity to avoid the first pass metabolism. Eplerenone buccal tablets were formulated by using direct compression method with different polymers like HPMC K 100M, Carbopol 934P, Carbopol 974P, Xantham Gum, Eudragit L100 and NaCMC in various concentrations and compositions. Incompatibility complications were not observed from the FTIR spectrums. The formulated and prepared buccal solid dosage forms were evaluated for pre-compressions and post- compression parameters such as hardness, weight variation, thickness, friability, surface pH, swelling index, in-vitro dissolution studies, drug content uniformity, mucoadhesion strength and mucoadhesion time. Evaluation results of formulation F12 are proven to be the optimal formulation showing highest mucoadhesion time, mucoadhesion strength and in-vitro drug release for prolonged period of time about 8 hours. Eplerenone is best delivered through buccal drug delivery system to enhance its oral bioavailability and bypass the hepatic first pass metabolism.

Chlorhexidine Mucoadhesive Buccal Tablets: The Impact of Formulation Design on Drug Delivery and Release Kinetics Using Conventional and Novel Dissolution Methods

Oropharyngeal candidiasis (OPC) is a mucosal infection caused by Candida spp., and it is common among the immunocompromised. This condition is mainly treated using oral antifungals. Chlorhexidine (CHD) is a fungicidal and is available as a mouth wash and oral gel. It is used as an adjuvant in the treatment of OPC due to the low residence time of the current formulations. In this study, its activity was tested against C. albicans biofilm and biocompatibility with the HEK293 human cell line. Then, it was formulated as mucoadhesive hydrogel buccal tablets to extend its activity. Different ratios of hydroxypropyl methylcellulose (HPMC), poloxamer 407 (P407), and three different types of polyols were used to prepare the tablets, which were then investigated for their physicochemical properties, ex vivo mucoadhesion, drug release profiles, and the kinetics of drug release. The release was performed using Apparatus I and a controlled flow rate (CFR) method. The results show that CHD is biocompatible and effective against Candida biofilm at a concentration of 20 µg/mL. No drug excipient interaction was observed through differential scanning calorimetry (DSC) and Fourier-transform infrared spectroscopy (FTIR). The increase in P407 and polyol ratios showed a decrease in the swelling index and an increase in CHD in vitro release. The release of CHD from the selected formulations was 86–92%. The results suggest that chlorhexidine tablets are a possible candidate for the treatment of oropharyngeal candidiasis.