Integrated Physical Pharmacy and Pharmaceutics I (Phar 2091) Unit 1 Introduction to dosage forms and routes of drug administration Dr. Mohd Yasir M. Pharm, Ph.D Assistant Professor Dept of Pharmacy, College of Health Sciences, Arsi University, Assela, Ethiopia 1 Drug ? Active drug substance (active pharmaceutical ingredient - API) Chemical compound with pharmacological action intended for used in diagnosis, mitigation, treatment, cure or prevention of disease. International non-proprietary names (INN, „generic“ names). Direct clinical use of the active drug substances is rare: Why?? API handling and Accurate dosing can be difficult or impossible (e.g., potent drugs: low mg and µg doses) API administration can be impractical/unfeasible because of size, shape, smell/odour, taste and low activity. Stability: Some API are chemically unstable in light, moisture, O2 API can be degraded at the site of administration (e.g., low pH in stomach). API may cause local irritations or injury when they are present at high 2 concentrations at the site of administration. Dosage forms: Definition: Drugs are rarely administered in their original pure state. They are converted into suitable formulation which are called dosage forms. Every dosage form is a combination of the drug and other non-drug components. Dosage forms are the means by which drug molecules / APIs are delivered to sites of action within the body/ topically to produce optimum desired effects and minimum side/adverse effect. Need of dosage forms: overcoming the difficulties of API 1. To provide for the safe and convenient delivery of accurate dosage Examples: Tablets, Capsules, syrups 2. Protection of form atmospheric oxygen or moisture. Examples: coated tablets, sealed ampoules/vials 3. Protection of a drug substance from gastric acid after oral 3 administration. Example: enteric coated tablets 4. To conceal the bitter taste, obnoxious odor of a drug substance. Examples: Capsules, coated tablets, flavored syrups 5. To provide liquid preparations of substances that are either insoluble or unstable in the desired vehicle. Example: suspension 6. To provide liquid dosage forms of substances soluble in desired vehicle. Example: solution 7. Sustained release and controlled released medication. 8. Optimal drug action for topical administration sites. ointments, creams, ophthalmic, ear and nasal preparations 9. Insertion of drugs into body cavities like Examples: rectal and vaginal suppositories 10. To provide for the placement of drugs within body tissues. Examples: Implants 11. To provide for the optimal drug action through inhalation therapy. Examples: inhalants and inhalations. 4 Classification of Dosage form Solid dosage forms Unit dosage forms Bulk Liquid dosage forms Biphasic Emulsion Suspension Tablets Capsule Powders Pills Internal Fine powders & granules External Dusting powders Insufflations Dentifrice Snuffs Monophasic Internal Syrups Elixirs Linctus Drops Gaseous Semi solid dosage e.g. forms Aerosols, Inhalation Internal (Non oral) External Liniments Lotions Gargles Throat paints Mouth washes Sprays Eye lotions Eye drops Nasal drops External Ointment Creams pastes Jellies Suppositories Pessaries 5 Solid dosage forms One of the oldest dosage forms Most of the solid dosage forms are available in Unit dose (exact quantity of the drug administered at once). Eg. e.g. Tablets, Capsule, pills, cachets etc. When drugs are to be administered orally in dry state, then tablets, capsules are most convenient dosage forms. Some solids are supplied in bulk (Means quantity available in large). Bulk powders can be supplied as Internal (Granules, Fine powders) as well as External (Dusting Powders, Insufflations etc). 6 1. Dusting Powders: Applied externally to skin in a very fine state (passed through sieve no 80) to avoid local irritation. Prepared by mixing of more than one ingredients in which either starch, kaolin or talc are used in their formulation. Generally talc or kaolin are used because they are inert in nature. Dusting powders are used for, astringent, antiperspirant , antiseptic, absorbent etc. May be two sub type: I) Medical dusting powder: used to increase superficial condition of skin. These are not applied on wounds, burns etc II) Surgical Dusting powders: used in body cavities and on major wounds like as burns etc. They should be sterilized before use. They are mainly used for their antiseptic, absorbent action. 7 2. Insufflations These are medicated dusting powders meant for introduction into body cavities (nose, throat, ear, vagina etc) with the help of an apparatus known as a insufflator that sprays the powders (in a state of fine particles) on site of application. 3. Snuffs These are finely divided solid dosage forms of medicaments which are inhaled into nostrils. They are mainly used for their antiseptic, bronchodilator and decongestion action. 4. Cachets /Sachets Consists of a dry powder enclosed in a shell. Usually unit dosage form Before administration, a cachet should be immersed in water for few seconds and then placed on the tongue and swallowed 8 5. Dentrifices (Tooth preparations) Dentrifices are preparations, used with the help of tooth brush for cleansing the surfaces of the teeth. They are available in the form of fine powders and pastes. They contain 1. Some abrasive substance like calcium sulfate, magnesium carbonate, sodium carbonate in fine powder. 2. Sweetening agent e.g. saccharin sodium 3. a suitable flavour e.g. peppermint oil, clove oil. 6. Granules Granulation is the process in which primary powder particles are made to adhere to form larger multiparticle or large particles entities called granules exhibiting better flow properties during tabletting 9 These powders are mixed with suitable excipient along with granulating agent (starch past), prepare a coherent mass & passed through the sieve to obtained desired size of granules and then dry. E.g. Effervescent granules Effervescent granules: are meant for internal use and quick action They contained medicaments mixed with citric acid, tartaric acid & sodium bi carbonates, sometime saccharin or sucrose may be added for sweetening taste. Before, administration desired quantity of granules are dissolved in water, the acid & bicarbonate reacts with each other to produce effervescence. The quantity of acid is slightly more than is necessary to neutralise the sodium bicarbonate because effervescent preparations are more palatable if slightly acidic. 10 CH2COOH HO C COOH CH2COONa . H2O + 3 NaHCO3 = HO CH2COOH H Tartaric acid 3CO2 + 4H2O Ttrisodium citrate H H HO C COOH + CH2COONa Citric acid (monohydrate) HO C COOH C COONa + 2 NaHCO3 = HO C COONa HO C COONa + 2CO2 + 2H2O H Disodium tartarate Capsules Capsules are solid unit dosage form in which one or more medicaments are enclosed in a water soluble, biodegradable shell made up of gelatin. 11 Mainly for oral administration (intended to be swallowed whole) but soft gelatine capsules may be intended for rectal or vaginal insertion as suppositories. Capsules are of two types: Hard gelatin capsules and Soft gelatin Capsules Hard gelatin capsules: also known as dry-filled capsules. Hard gelatin capsules consists of two parts known as capsule body (longer part, slightly narrow) and the capsule cap (the shorter part, slightly broad). The drug substance placed in the body and the caps are sided over it, hence enclosing the drug substance. Soft gelatin capsules are flexible in nature. They may be spherical, ovoid cylindrical or tubes. The small spherical capsules are also known as ‘pearls’. soft gelatin 12 capsules are used to enclose solids, semisolids or liquids. Tablets These are unit solid dosage forms of medicaments meant for oral administration, which are prepared by moulding or by compression with or without Excipients. The tablets can be prepared by two methods namely as a I) Dry granulation, II) Wet Granulation Pills These are small, rounded solid dosage forms containing medicaments intended for oral use. The mass is rolled to uniform pill pipe, which cut into numbers of uniform pills. Sometimes pills are coated with varnish, gold leaf, etc to improve finish, unpleasant taste & stability. Now a days pills are outdated preparations as difficult to prepare 13 pills of uniform size & weight Lozenges Lozenges are solid dosage form of medicaments which are meant for slow dissolution in the mouth. Along with medicament they contain a sweetening agent, flavoring agent and a strong binding agent. They may be prepared either by moulding or by compression. Examples are compound bismuth lozenges, liquorice lozenges 14 Liquid dosage forms It may be defined as “A solution is a liquid-preparation that contains one or more soluble chemical substances dissolved in a specified solvent” Liquid dosage forms are intended for External, Internal or parenteral use. The component of the solution which is present in a large quantity is known as “SOLVENT” where as the component present in small quantity is termed as “SOLUTE” Advantage Immediately available for absorption. Administration convenient, particularly for infants, psychotic patients as are easier to swallow than solids and are therefore particularly acceptable for pediatric patient. 15 Disadvantage Less stable in aqueous system. Incompatibility is faster in solution than solid dosage form. Patients have no accurate measuring device. Accident breakage of container results in complete loss. Solution often provide suitable media for the growth of micro organisms. The taste of a drug, which is often unpleasant, is always more pronounced when in solution than in a solid form. Bulky than tablets or capsule, so difficult to carry transport. They mainly classified in to two category namely as – I) Monophasic Liquid dosage forms. II) Biphasic liquid dosage forms. 16 Monophasic liquid dosage forms Monophasic liquid dosage forms are represent by true or colloidal solution. A solution is homogenous because the solute is an ionic or molecular forms of subdivision. In case of colloidal solutions, the solutes are present as aggregates although they cannot be seen by necked eye or ordinary microscope. It is sub classified as – I) Internal Use, II) External use 17 Monophasic Liquid Dosage forms Internal Use Syrup Elixirs Linctuses Drops Draught Single dose liquid is known as Draught External Use Liniments Applied Lotions to skin Gargles Mouth Wash For Throat paints body cavities sprays Inhalations Nasal drops Eye drops Eye lotions Ear drops 18 Monophasic liquid dosage forms for Internal Use 1. Syrup It is a concentrated or saturated solutions of sucrose in purified water. The concentration of sucrose is 66.7% w/w (I.P)/64.74 % w/w or 85 % w/v (USP) & due to that it is a viscous preparations. The syrup which contains medical substance called as a medicated syrup & those containing aromatic or flavored substance known as a flavored syrup. Importance of syrup It retards oxidation because its partly hydrolyzed into reducing sugar. It prevents decomposition of many vegetable substance because its have high osmotic pressure which prevent the growth of bacteria. They are palatable due sweet taste. 19 2. Elixirs It is clear, sweetened, aromatic, hydroalcholic preparations (10 20%) meant for oral use. The medicated elixirs are generally contained potent drug like as antibiotics, antihistamine or sedative , where as non – medicated elixirs contained flavoured. The composition of elixirs contained mainly as ethyl alcohol (active ingredients),water, glycerin or propylene glycol, colouring agent, flavouring agent & preservative. 3. Linctuses These are viscous liquid preparations that’s are used for the treatment of cough. They contain medicaments which have demulcent (which soothes the inflammed mucous membrane ), sedative, expectorant action. They are taken in small doses without diluting with water to have prolonged effect of medicines. 20 Simple syrup is used as a vehicle for most of the linctuses. 4. Drops These are liquid preparations meant for oral administration. The oil soluble vitamins, such as vitamin A & D concentrates in fish – liver oil are presented as drops for administration. Since these preparations contain potent medicaments, the dose must be measured accurately. The following two methods are commonly used for this purpose. Use of a dropper which is accurately graduated in fractions of a milliliters. Use of a pre – calibrated dropper. Monophasic liquid dosage forms for External use 1. Liniments Liniments are liquid or semi- liquid or semi- solid preparations applied to the skin with friction & rubbing of the unbroken skin. Are usually alcoholic and oily liquid preparations. 21 Used generally for their rubefacient and counterirritant effects due to presence of turpentine or methyl salicylate . Camphor is added to promote the local action. Liniments should not be applied to skin that are bruised or broken. They can be applied on lint and then placed on effected area Lotions Are the liquid preparations intended for external application without friction or rubbing to the affected area Usually applied with the help of some absorbent material such as cotton wool or gauze. It is generally used to provide cooling, soothing and protective & antiseptic action. Gargles Gargles are aqueous solutions used for treating throat infection 22 (pharynx and nasopharynx part) Supplied in concentrated forms with directions of dilution with warm water before use They are used into intimate contact with the mucous membrane of throat for few seconds, before they are thrown out of the mouth. They are used to relieve soreness in mild throat infection. Mouth wash/ mouth rinse These are hydroalcoholic solutions with pleasant or acceptable taste & odour These are used to make clean & deodorise the buccal cavity or used for oral hygiene and to treat infections of the mouth. They mainly contain antibacterial agent, alcohol, glycerin, sweetening agent, flavoring agent & colouring agent. Dilution is not required Throat paints are viscous liquid preparations used for mouth and throat infections 23 Glycerin is commonly used as a base because being viscous it adheres to mucous membrane for long period and it possess a sweet taste. Inhalations These are liquid preparations containing volatile substance & are used to relieve decongestion & inflammations of respiratory tract. The volatile substance in inhalations would be volatile at room temperature so that they should be placed on some adsorbent pad or handkerchief. In some cases inhalations will added to hot water (650c) then vapors will inhaled. Nasal drops Drugs in solution may be instilled into the nose from a dropper or from a plastic squeeze bottle. The drug may have a local effect, e.g. antihistamine, decongestant.24 Alternatively the drug may be absorbed through the nasal mucosa to exert a systemic effect. The use of oily nasal drops should be avoided because of possible damage to the cilia of the nasal mucosa & if it is used for long period may reach the lungs & cause lipoid pneumonia. To avoid that Nasal drops are prepared so that they are similar in many respects to nasal secretions, so that normal ciliary action is maintained thus aqueous nasal solutions usually are isotonic and slightly buffered to maintain a pH of 5.5 to 6.5. Eye drops/Ear drops Sterile, aqueous/oily solutions intended for instillation in eye sac. Single dose container should not contain anti-microbial preservative. In case of multi dose container a dropper should be supplied with it for administration. 25 Extracts Extracts are concentrated preparations containing the active principles of vegetable or animal drugs Tinctures These are alcoholic preparations containing the active principles of vegetable drugs. They are weaker than extracts. Spirits Spirits are alcoholic or hydroalcoholic solutions of volatile substances. Most are used as flavouring agents but a few have medicinal value. Infusions (i) Fresh Infusions are made by extracting vegetable drugs for a short time with cold or boiling water (making of tea). They quickly deteriorate as a result of microbial contamination and therefore must be used within 12 hours. (ii) Concentrated infusions are made by cold extraction with 25 % 26 alcohol. The alcohol preserves the product for an indefinite period. Biphasic liquid dosage forms They are sub categorized into two different forms namely as – I) Emulsion II) Suspension Emulsion is a biphasic liquid preparations containing two immiscible liquid (Continuous Phase & dispersed phase) made missicible. The liquid which is converted into minute globules is called as dispersed phase & the liquid in which the globules are dispersed is called the continuous phase Two Immiscible Liquids dispersed phase continuous phase Dispersed Phase (Internal phase) Continuous Phase (External phase) An emulsion is a thermodynamically unstable system consisting of at least two immiscible liquid phases one of which is dispersed as globules in the other liquid phase stabilized by a third substance called emulsifying agent. The globule size in emulsion varies from 0.25 to 25 µm. 27 Types of emulsions 28 Simple type Water in oil (w/o) Oil in water (o/w) Depending on globule size Micro emulsion: Fine emulsion: have a milky appearance. Special type Multiple emulsion (w/o/w, o/w/o) Water in oil (w/o) 29 In this types of emulsion water is dispersed phase & oil is continuous phase w/o types of emulsion generally meant for External use. Examples are butter, lotions, creams etc. In rare case they are used internally. Water is dispersed phase Oil is continuous phase Oil in water (o/w) 30 In this types of emulsion oil is dispersed phase & water is continuous phase o/w types of emulsion meant for both Internal use & External use. Examples for internal use are Vitamin A in corn oil, liquid paraffin in water etc. Examples for External use are Benzyl benzonate emulsion. Oil is dispersed phase water is continuous phase Micro Emulsion 31 These are clear dispersions of o/w or w/o in which the globules have small size like as a 10nm or 0.01 µm.. Being cleared products micro emulsion are more popular now a days. Micro emulsions are thermodynamically stable optically transparent , mixtures of a biphasic oil –water system stabilized with surfactants. Multiple emulsion These are emulsion with in emulsion & designated as w/o/w or o/w/o. The drugs that is incorporated in the innermost phase must cross two phase boundaries before getting absorbed. It is generally used in oral sustained release or intramuscular therapy. Suspension 32 are the biphasic liquid dosage forms of medicament in which finely divided solid particles ranging from 0.5 to 5 micron are dispersed in a liquid or semisolid vehicle with aid of single or combination of suspending agent. In which solid particles acts as disperse phase where as liquid vehicle acts as continuous phase The external phase (suspending medium) is generally aqueous in some instance (oral use), may be an organic or oily liquid for non oral use. Advantage of suspension Suspension can improve chemical stability of certain drug. E.g. Procaine penicillin Drug in suspension exhibits higher rate of bioavailability than other dosage forms. Solution > Suspension > Capsule > Compressed Tablet > Coated tablet Duration and onset of action can be controlled. E.g. Protamine Zinc-Insulin suspension. Suspension can mask the unpleasant/ bitter taste of drug. E.g. Chloramphenicol 33 Difference between flocculated & deflocculated suspension Flocculated Suspension Deflocculated suspension Particles form loose aggregates & forms network like structure. Particle exist as separate entities. Particles experience attractive forces. Particles experience repulsive forces. Supernatant liquid is clear. Supernatant liquid is cloudy. The rate of sediment is high. The rate of sediment is slow. Sediment is rapidly formed. Sediment is slowly formed. sediment are loosely packed, hence hard cake is not formed. Sediments are closely packed, hence hard cake is formed. The sediment is easy to redisperse on shaking. Sediment is difficult to redisperse on shaking. (due to formation of hard cake) Bioavailability is comparatively less. Bioavailability is relatively high. The suspension is not pleasing in appearance. The suspension is pleasing in appearance. 34 Semisolid dosage forms 35 Semisolid dosage forms meant for external application Semisolid dosage forms subcategorized are asI) ointment II) creams III) paste IV) Jellies V) Suppositories The suppositories are also included in this category but it is a unit dosage forms. Creams According to the FDA’s, “…a cream is an emulsion usually containing > 20% water and volatiles and/or < 50% hydrocarbons, waxes, or polyols as the vehicle.” Creams are thicker than lotion (o/w- Hydrophilic creams or w/oHydrophobic creams ) and Softer than ointments/paste and are preferred as easy removal from containers and good spreadability over the absorption site These are viscous semisolid emulsions which are meant for external use. Cream is divided in to two types namely as I) Aqueous creams II) Oily creams In case of aqueous creams the emulsions are o/w type & it is relatively non greasy. In case of oily creams w/o type & it is relatively greasy. Stay short time on skin than ointment. 36Healing power and absorption is more than ointment Ointment Ointment are semisolid preparation meant for application to skin or mucous membrane for their protective or emollient (softening or soothing ) properties According to the FDA’s, “…a ointment is an emulsion or suspension usually containing < 20% water and volatiles and/or > 50% hydrocarbons, waxes or polyols as the vehicle.” Non-porous - hence perspiration cannot escape through it. Pastes Semisolid preparations intended for external application to skin. Generally very thick & stiff. Do not melt at ordinary temperature & thus forms a protective coating over the area where they are applied. They are porous so the perspiration (sweat)can escape through it. Pastes are differ from ointment as they contain a high proportion of 37 finely powdered medicaments (20-50 %) . So less greasy then ointment Jellies are transparent or translucent, non greasy, semi solid preparations mainly used for external application to skin. The substance like gelatin, starch, tragacanth, sodium alginate & cellulose derivatives are used for the formulation of jellies. Cross linking i.e. there. Suppositories: Semisolid formulation for insertion to body cavities (vagina, urethra etc). Poultice: a soft, moist mass of material applied to the body to relieve soreness and inflammation and kept in place with a cloth. 38 Pharmaceutical Ingredients/Additives/ Non active part of drug Definition: An excipient is a pharmacologically inactive substance formulated alongside the active pharmaceutical ingredient of a medication. Ideal properties of Excipients Feasible No interaction with drug Excipients Cost effective 39 Stable Pharmacologically inert Purposes served by excipients: Provide bulk to the formulation in case of small dose of API Facilitate drug absorption or solubility and other pharmacokinetic considerations. Aid in handling of “API” during manufacturing . Provide stability and prevent from denaturation . etc. Categories of Pharmaceutical Excipients 1. Fillers/diluents/ bulking agents: Add volume and/or mass to a drug substance. Used in tablets and capsules. Dibasic calcium phosphate are used popularly as fillers. Other examples of fillers include: lactose (most commonly used but exhibit Millard reaction), anhydrous lactose (stable), sucrose, glucose, mannitol (chewable tablet), sorbitol, calcium carbonate 40 Binders: Binders hold the ingredients in a tablet together . Binders ensure that tablets and granules can be formed with required mechanical strength. May be 1. Solution binders: are dissolved in a solvent (for example water or alcohol can be used in wet granulation processes). Examples include gelatin, polyvinylpyrrolidone, starch, and polyethylene glycol. 2. Dry binders are added to the powder blend, either after a wet granulation step, or as part of a direct powder compression (DC) formula. Examples: methyl cellulose, polyvinylpyrrolidone and polyethylene glycol. 41 Disintegrants Facilitate breakup of tablets and contents of capsules into smaller particles for quick dissolution when it comes in contact with water in the GIT. Examples: Sodium starch glycolate, Microcrystalline cellulose (MCC), Croscarmellose sodium, Crospovidone, Ac-Di-Sol(Sodium Carboxy methyl cellulose Na-CMC) Coating Agent : for tablet coating Layer of coating material is applied to the surface of a dosage form Function of coating agents: Protection form moisture (film coating), taste masking (sugar coating), protection for gastric pH (enteric coating) elegance, ease of swallowing, identification etc. Examples: Carboxy methyl cellulose sodium (CMC), Carnauba Wax, Cellulose acetate, phthalate (CAP/used in enteric coating), 42Zein & Shellac (sealing agent). Lubricants, Antiaherent and Glidants – Lubricants are intended to reduce friction during tablet ejection between the walls of tablet and die cavity by interposing an intermediate layer. Stearates, waxes – Antiaherent prevent adhesion of the tablet materials to the surface of dies and punches, reduce inter particle friction and may improve the rate of flow of the tablet granulation. Eg talc – Glidants are intended to promote flow of granules or powder material by reducing the friction between the particles. Eg. Silicon dioxide (Cab-O-Sil, Aerosil in 0.25-3% conc) Preservatives protects the product against microbial proliferation/growth and maintain the stability of product during its self life. Methylparaen, 43Ethyl parabens, Propylparaben, Butylparaben, Benzoic acid and its salts Antioxidant: An antioxidant is a molecule that inhibits the oxidation of other molecules. a. Oxidation: Oxidation is defined as loss of electrons or addition of oxygen. b. Auto-oxidation: It is a reaction with oxygen of air which occurs spontaneously without other factors. c. Pre-oxidants: These are substances catalyze oxidation process e.g., metals, some impurities. Preservation against oxidation Addition of Primary antioxidant: act by interfering with the propagation step of auto-xidaton process. e.g., Natural antioxidant: Tocopherol (Vitamin E), Gallic acid, Synthetic antioxidant : Sodium Metabisulfite (Water soluble) and Butylated hydroxyl anisol/BHA & Butylated hydroxyl 44 tolune /BHT (Oil soluble) Sweetening agents added primarily to chewable tablets/in liquid formulations designed for oral administration specifically to increase the palatability of the therapeutic agent. Example: natural sugar like Sucrose, Lactose, Sorbitol, Mannitol (extensively used in chewable tablets ) etc and artificial sugar Saccarine, Aspertame. Flavouring agents are used to impart pleasant, smell to the preparation and to mask specific type of taste of the preparation, thus make them more palatable and improve patient acceptance. Ex. pineapple, clove, lemon oil, orange, rose,vanilla, Menthol. Coloring agents impart the preferred color to the formulation. Example: 1.White: Titanium dioxide (Opacifier) 2. Blue :Brilliant blue ,Indigo carmine 3. Red :Amaranth Carmine 4.Yellow: saffron 5.Green45 Erithrosine, 6.Brown: caramel Solvent Used can dissolve a solute Can be Polar and Non polar Polar solvent dissolves polar compound best and non polar solvent dissolves non polar compound best. The first choice for a solvent is water in which a drug is freely soluble. Non Aqueous Solvent May be nonaqueous but water miscible (e.g. Ethanol, propylene glycol, glycerol, sorbitol) and Nonaqueous and water immiscible vehicle e.g. vegetable oils (used for parenteral as well as skin preparation) Co-solvent Co-solvents are defined as water-miscible organic solvents that are used in liquid drug formulations to increase the solubility of poorly water soluble substances or to enhance the chemical stability of a 46drug. Eg. Ethanol, propylene glycol, glycerol, sorbitol Chelating agent Chelating agents are stabilizing agents that are capable of forming complexes with the metalic impurities EDTA: ethylene diamine tetraacetate is used for the estimation of metals ions . Calcium Disodium Edetate: it is used in the treatment of heavy metal poisoning mostly caused by lead. Buffering agent resist any change in pH of solution upon addition of an acid or an alkali. Most of the buffering system are based on carbonate, citrates, gluconates , lactates, phosphates, or tartrates. Viscosity Enhancers Hypromellose, hydroxyethylcellulose, polyvinyl alcohol, povidone, 47 dextran, carbomer 940. Isotonicity Adjusters Sodium chloride, potassium chloride etc Humectants Added in externally use preparation Retains the moisture of skin and prevent the drying. Eg. ethylene glycol, polyethylene glycol (PEG), glycerin. Surfactants : Compounds that lower the surface tension (or interfacial tension) between two liquids or between a liquid and a solid and increase the solubility. They are also known as surface active agents. A surfactant contain lipophilic region (tail) and hydrophilic region (head/ charge present here) Types of surfactants : There are of four types of surfactants a) Anionic surfactants: here the hydrophilic region is negatively Sodium lauryl sulphate, Ammonium 48charged i.e. an anion). Eg. lauryl sulphate 2. Cationic surfactant (here hydrophilic region is positively charged i.e. a cation) Cetyl trimethyl ammonium bromide ( cetrimide ) - is an effective antiseptic agent against bacteria and fungi Benzylkonium chloride 3. Non-ionic surfactants : Tween 80 (Polysorbate 80 / polyoxyethylene sorbitol monooleate)is an excipient that is used to stabilize aqueous formulations of medications for parenteral administration Span ( sorbitan ester of lauric acid ) 4. Amphoteric surfactant : Lecithin and N-dodecyl alanine. 49 First pass Metabolism The first-pass effect is the term used for the hepatic metabolism of a pharmacological agent when it is absorbed from the gut and delivered to the liver via the portal circulation. The greater the first-pass effect, the less the agent will reach the systemic circulation when the agent is administered orally Where ? Liver Gut wall Gut Lumen Result ? Low bioavailability. Short duration of action (t ½). 50 Routes of administration A drug will produce its action only when it enters the body, tissue or cells (i.e. site of action) Entrance through which a drug is delivered is called the route of drug administration. Classification 51 1. ORAL ROUTE The Most common route and Drug is given through oral cavity absorbed from the gastro-intestinal tract Advantages Safe, Convenient- self- administered, pain free, non-invasive and easy to take Preparations are economical as compared to other parenteral routes No need for sterilization Disadvantages Slow absorption slow action - can not used in emergency Irritable and unpalatable drugs (e.g. paraldehyde)- nausea and vomiting Cannot be used Unco-operative, vomiting and unconscious patients Some drugs destroyed by digestive juices (e.g. penicillin G, 52 insulin) Sometimes inefficient drug absorbed, some drugs are not absorbed like streptomycin First-pass effect- Due to Biotransformation in liver (e.g., nitroglycerin, testosterone, lidocaine). Food–Drug interactions and Drug-Drug interactions 53 2. SUBLINGUAL OR BUCCAL The tablet or pellet containing the drug is placed under the tongue (sublingual) or crushed in the mouth and spread over the buccal mucosa. The drug is absorbed through the buccal mucosa. e.g. nitroglycerine, isoprenaline, clonidine, nifedipine. Advantages Disadvantages Drug absorption is quick Unpalatable & bitter drugs con not administered Quick termination Irritation of oral mucosa First-pass avoided Large quantities not given Can be self administered & Economical Few drugs are absorbed, small dose 54 3. RECTAL ROUTE The drug containing dosage form is either inserted or put into the rectum as suppositories or retention enema. One part of the absorbed drug passes to the liver (superior haemorrhoidal vein drains into the hepatic portal vein which flows to liver), another part to the systemic circulation (drug passes through inferior and middle haemorrhoidal veins drain directly into the systemic circulation via the inferior vena cava). Advantages: this route can also be used Drugs having bad taste or odour and degrades in acidic pH of the gastric juice Patient is having recurrent vomiting. Disadvantages: Inconvenient and embarrassing route Absorption is slower, irregular and often unpredictable. 55 4. Inhalation The drug is administered through nose or mouth, carried by the air to reach the lung. The alveoli are rich with capillary vessels. The drug is diffused into the blood stream. Thus systemic action is obtained. Advantages: (i) Absorption takes place from the vast surface of alveoli - hence action is very rapid. 5. Nasal The drug is administered as snuff or spray or nebulized solution in the nose; where the drug penetrates the nasal mucous membrane to reach the blood. Advantages: (i) The drug can avoid digestive juices and liver. 56 6. Parenteral (Par- beyond, enteral- intestinal) Routes of drug administration other than oral route are known as parenteral route. This refers to administration by injection which takes the drug directly into the tissue fluid or blood without having to cross the intestinal mucosa and subsequently liver. a) Intradermal (I.D.) (into skin) b) Subcutaneous (S.C.) (into subcutaneous tissue) c) Intramuscular (I.M.) (into skeletal muscle) d) Intravenous (I.V.) (into veins) e) Intra-arterial (I.A.) (into arteries) f) Intrathecal (I.T.) (cerebrospinal fluids ) g) Intraperitoneal (I.P.) (peritoneal cavity) h) Intra - articular (Synovial fluids) 57 Advantages high bioavailability Rapid action (emergency) No first pass metabolism Disadvantages Infection Sterilization. Invasive assistance require Suitable for Pain Vomiting &unconsciousness Needs skill Irritant & Bad taste drugs. Anaphylaxis No gastric irritation Expensive No food-drug interaction Dosage form: Vial or ampoule 58 A) Intra-dermal injection drug is injected into the dermis of skin. route is employed for specific purpose only like BCG vaccine, sensitivity testing of drugs. B) Subcutaneous injection The drug is injected under the skin. The drug is deposited in the loose subcutaneous tissue which is richly supplied by nerves (irritant drugs cannot be injected) oily solutions or aqueous suspensions can form a depot which will release drug slowly for a prolonged period. Eg. e.g. Insulin injection. C) Intramuscular injection The drug is injected in one of the large skeletal muscles59 deltoid, triceps, gluteus maximus, rectus femoris etc. Advantages: Muscle is less richly supplied with sensory nerves, hence mild irritants can be injected. Muscle is more vascular hence absorption is faster than subcutaneous route. It is less painful. Depot preparations can be injected by this route and the action of the drug may be prolonged. Disadvantages: Since deep penetration is needed hence self-medication is not possible. Large volume cannot be given. e.g. Low volume injections - Vitamin A, hydrocortisone acetate, tetanus toxoid, antibiotic etc. 60 D) Intravenous The drug is injected as a bolus or infused slowly over hours in one of the superficial veins (generally brachial vein). Advantages: The drug directly reaches the blood stream and effect is produced immediately, hence, this route can be used in emergencies. The inside of the veins is insensitive and drug gets diluted with blood quickly, therefore, even highly irritant drugs can be injected intravenously. Large volumes can be infused (e.g. normal saline). It is useful in unconscious patients. Desired blood concentration can be achieved. Disadvantages: Drugs that precipitate in the blood cannot be administered. Only aqueous solution can be administered. If the needle puncture the vessel (i.e. extra vasation) then 61thrombophlebitis of the injected vein and necrosis of the adjoining tissues may occur. No drug can be given in depot form - so the action is not prolonged compared to other parenteral administrations. Once administered, withdrawal of the drug is not possible. E) Intra-arterial A drug is injected into an artery. The effect of a drug can be localized in a particular organ or tissue by choosing the appropriate artery. Anticancer drugs are sometimes administered by this route. F) Intra-peritoneal In this route a drug is injected into the peritoneal cavity. By this route fluids like glucose and saline can be given to children. 62 G) Intra – articular injections of antibiotics and corticosteroids are administered in inflammed joined cavities by experts. example: hydrocortisone in rheumatoid arthritis 7. Transdermal/ cutaneous route The dosage form is applied or placed on the skin and the drug penetrates the skin to reach the blood i.e. cutaneous route is meant for systemic absorption. Advantages: (i) Highly lipid soluble drugs can be applied over the skin for slow and prolonged absorption. (ii)The liver is bypassed through this route. Disadvantages: (i) Absorption is very slow. So it cannot be used in emergency situation. (ii)Water soluble drugs are minimally absorbed through the skin. 63 8. Topical Routes of Administration Application of a drug directly to the surface of the skin Includes administration of drugs to any mucous membrane eye – vagina Nose – urethra ears – colon lungs Dose forms for topical administration include: Skin: creams ointments • Eye or ear: lotions – solutions gels – suspensions transdermal patches – ointments • Nose and lungs: 64 – sprays and powders