MEDICAL UNIVERSITY – PLEVEN DEPARTMENT OF PHARMACOLOGY DRUGS & DOSAGE FORMS Dr G. Stavreva, Dr D. Pendicheva THE ORIGIN OF DRUGS GALENIC PREPARATIONS (PHYTOMEDICINALS) FORMULATION OF DRUG SUBSTANCES SOLID DOSAGE FORMS LIQUID DOSAGE FORMS SEMISOLID DOSAGE FORMS AEROSOLS THE ORIGIN OF DRUGS Modern drugs, available for use today, are obtained from many sources: 50% of total prescriptions are composed of synthetic or semisynthetic (based on natural active ingredients) chemical agents 25% contain higher plant principles 12% are microbial-derived products 7% are mineral in character 6% are animal-derived I. Classification of drug sources 1. Natural sources of drugs 1.1. Higher plants: the whole plant, leaves, root, bark, seeds, flowers 1.2. Microorganisms: bacteria, fungi, molds 1.3. Minerals 1.4. Animals: organs, tissues, corporal fluids 2. Synthetic sources of drugs 2.1. Inorganic elements and compounds 2.2. Organic compounds II. Natural sources of drugs The discipline of pharmacognosy deals with information on drugs from plant and animal sources and their constituents. The plant or animal as a “row material” is composed of many chemical substances, commonly termed ingredients: Active ingredients exert a physiological effect and they are responsible for the therapeutic activity of the natural drug. Inert ingredients have no definite pharmacological activity but their presence may modify the absorbability or potency of the active constituents. The term crude drug is usually applied to any part of plant or animal organs, or whole organisms, either in the fresh state or dried and either grounded or ungrounded. Natural drugs are used in their crude form, or active ingredients are extracted and purified for therapeutic use. 2 1. Higher plants Plants are biosynthetic laboratory for a multitude of chemical compounds: glycosides, alkaloids, steroids. The active ingredients might be found in any part (or all parts) of the plant: leaves, root, bark, seeds, fruits, flowers, etc. 2. Microorganisms Microbial metabolites used as drugs, especially the antibiotics and antineoplastic agents are produced by fermentation. a strain of mold Penicillium chrysogenicum produces Penicillin G Clavulanic acid is a product of fungus Streptomyces clavuligerus Microorganism from sea water, identified as Cefalosporium acremonium, gives material for the production of semisynthetic cephalosporins Streptomycine was isolated from a strain of Streptomyces griseus Gentamicin is produced by Micromonospora purpurea, an actinomycete 3. Minerals Precipitated sulfur is a very fine powder for external use, acting as parasiticide, which is used in the treatment of skin disorders Purified sulfur is used internally only, as a laxative Talc powder is an absorbent, etc. 4. Animals Animal organs, tissues, fluids and other animal derivatives can be used to obtain active ingredients: Beef and pork pancreas are the source of the natural insulin sold today Exogenous thyroxine can be obtained from the thyroid glands of animals, usually pigs Most commercial preparations of Corticotrophin are obtained from either hog or sheep pituitary glands Vesicular extracts from sheep and bulls are used to yield prostaglandins III. Synthetic sources of drugs In searching for similar activity, many new drugs have been synthesized. Semisynthetic drugs are based on natural ingredients: Reserpine and synthetic antipsychotic agents Morphine and synthetic analgesics Curare and synthetic neuromuscular blockers Adrenaline and amphetamines Hormones, vitamins, antiepileptic drugs, synthetic antibiotics are only a small part of the modern drugs, produced by synthesis. 3 Plant Species Popular name Crude Drug Active ingredients Pharmacological action Drug Atropa Belladonna Deadly night shade roots Radix Belladonnae anticholinergic: antispasmodic,antisecretory, mydriatic, CNS-activity Atropine Scopolamine Datura stramonium Jimson weed, thorn apple leaves Folium Stramonii anticholinergic: antispasmodic,antisecretory, mydriatic, CNS-activity Asthma cigarettes Hyosciamus Niger Papaverum somniferrum Opium poppy leaves Folium Hyosciami opium – dried exudate of the incised seed capsule leaves Folium Digitalis leaves Folium Digitalis seeds Semen Strophanthi the overground part Herba Adonidis vernalis roots Radix Rauwolfiae roots end rhizome Radix et rhizoma Valerianae bark Cortex Chinae anticholinergic: antispasmodic, antisecretory, mydriatic,CNS-activity Asthma cigarettes Henbane alkaloids: atropine, hyosciamine, hyoscine (scopolamine) alkaloids: atropine, hyosciamine, hyoscine (scopolamine) alkaloids: atropine, hyosciamine, hyoscine (scopolamine) alkaloids: morphine, codeine, papaverine cardiac glycosides centrally acting analgesics, antitussives, smooth muscle relaxant (papaverine) cardiotonics Morphine Codeine Papaverine cardiac glycosides cardiotonics Digitoxin Digoxin Strophanthin G and K cardiac glycosides cardiotonics cardiac glycosides mild cardiotonics sedatives hypotensive, antipsychotic Digitalis Purpurea Digitalis Lanata Strophanthus Gratus et Kombe Foxglove Adonis Vernalis Rauwolfia serpentine Valeriana officinalis Pheasant’s eye Cinchona Grecian Foxglove Chandrika, Patalagandhi alkaloids: reserpine Digitoxin Adinorm Reserpine volatile oil, valerenic acid and valepotriates sedatives Valeriana alkaloids: quinidine, quinine, cinchonine Quinine Quinidine antiarrhythmic, antimalarial, antipyretic 4 GALENIC PREPARATIONS (PHYTOMEDICINALS) The term “Galenic preparations” is related to classes of natural drug products obtained from plants by using simplified pharmaceutical procedures. Such preparations (known as tinctures, extracts, syrups, spirits, aromatic waters, etc.) popularly have been called galenicals, after Galen, the 2nd century Greek physician. They are relatively impure products intended only for oral or external use, which consist of active ingredients in the same proportion as they are in the crude drug. I. Tinctures (tinctura, -ae, -ae) Tinctures are defined as alcoholic or hydroalcoholic solutions derived from plant crude drugs by maceration (soaking) or percolation (filtering). They are prescribed in small quantity (10 – 30 g) and are used as drops. Examples: Tinctura Valerianae; Tinctura Adonidis vernalis, Tinctura Strychni. II. Extracts (extractum, -i, -a) Extracts are defined as concentrated preparations of plant drugs obtained by removal of the active ingredients of the drug with suitable liquids and evaporation of all or nearly all of the solvent. Three forms of extracts are recognized: 1. Liquid extracts (extracta fluida) – liquid preparations. Examples: Extractum Althaeae fl. (Althaea officinalis – hollyhock) 2. Solid or pilular extracts (Extracta solida or spissa) – concentrated plastic masses, which are suited especially for use in pills, ointments and suppositories. Example: Extractum Valerianae spissum 3. Powdered extracts (Extracta sicca) – dry powders with contents of humidity less than 5%. Examples: Extractum Opii siccum, Extractum Belladonnae siccum. III. Syrups (Sirupus, -i, -i) – syrups are concentrated solutions of sugar in water. Types: 1. Simple syrups – contain sugar and water 2. Medicated syrups – contain some added medicinal substances 3. Flavored syrup contains aromatic substances or concentrated fruit juices (raspberry, cherry, strawberry). Simple and flavored syrups are useful for preparing liquid oral dosage forms (as Remedium corrigens). 5 Examples: Sirupus Codeini (antitussiva), Sirupus Rubi idaei (cherry syrup) IV. Aromatic waters (Aqae aromaticae s. medicatae) Aromatic waters, also known as medicated waters, are clear aqueous solutions of volatile oils or other aromatic substances. Their odor or taste is similar to those substances from which they were prepared. They are used principally as flavored and perfumed constituents. Examples: Aqua Menthae, Aqua Rosae, ets. V. Spirits (Spiritus medicatus) – Spirits are alcoholic solutions of volatile substances. They are used mainly externally. Examples: Spiritus Mentholi, Spiritus Lavandulae, ets. FORMULATION OF DRUG SUBSTANCES. CLASSIFICATION OF DRUG DOSAGE FORMS Drug substances and crude drugs are developed into drug dosage forms in order to optimize stability, safety and effectiveness of drug substances and to make them suitable for administration. According to the consistence, they are classified as: 1. Solid dosage forms 2. Liquid dosage forms 3. Semisolid dosage forms 4. Aerosols SOLID DOSAGE FORMS Solid dosages, such as tablets, have many advantages over other types: greater stability, less risk of chemical interaction between different medicaments, smaller bulk, accurate dosage, and ease of production. I. Classification of solid dosage forms 6 1. Powders 2. Tablets 2.1. Tablets for oral administration compressed tablets buccal tablets sublingual tablets chewable tablets effervescent tablets sugar-coated tablets film-coated tablets enteric coated tablets controlled-release tablets 2.2. Tablets for parenteral administration tablets for solution inserts pellets (tablets for implantation) 3. Capsules hard gelatin capsules soft gelatin capsules enteric-coated capsule 4.Granulae 5. Pills 6. Troches II. Characteristics of solid dosage forms POWDERS Historically, powders represent one of the oldest dosage forms. They posses some advantages: flexibility in compounding and relatively good chemical stability. The main disadvantages are their unsuitability for dispensing unpleasant tasting or hygroscopic drugs and inaccuracy of dose (for bulk powders). Classification of powders: 1. According to the division into prescribed doses: 7 bulk powders (Pulveres nondivisi) – all doses are given inseparably (as a bulk). They may be classified as: oral powders – e.g., antacid and laxative powders dentifrices dusting powders – locally applied nontoxic preparations. Commercial dusting powders are available in sifter-top containers and pressure aerosols. insufflations – finely divided powders introduced into body cavities (ears, nose, throat) with a powder blower (insufflator). Specialized equipment has been developed for the administration of micronized powders of relatively potent drugs (e.g., pressure aerosols) divided powders (Pulveres divisi) are divided into the prescribed number of doses and are given orally. Each individual dose (0.1–1.0 g) should be transferred to a powder paper. 2. According to the composition: simplex powders (Pulveres simpliciti) consist of one active ingredient and suitable inert substances (constituents) complex powders (Pulveres compositti) are mixtures of more than one active ingredient and constituents. TABLETS Tablets (tabuletta, -ae) are solid dosage forms containing drug substance with or without suitable diluents, and prepared by compression. This is the most frequently used dosage form of administering a drug. They are swallowed, chewed, or held sublingually. Scoring of some tablets into halves or quadrants facilitates breaking them if a smaller dose is needed. A tablet’s color or shape can help identify it. Advantages: simplicity and economy, stability and convenience in packaging, accuracy of dosage, compactness, portability, and ease of administration. Tablet types and their abbreviations: 1. Tablets for oral administration compressed (or plain) tablets (CT) – These tablets are formed by compression and contain no special coating. They are made from powdered, crystalline or granular materials, in combination with binders, diluents, etc. (e.g., Analgin, Aspirin, Paracetamol, Saridon, etc.) sublingual tablets (linguettae s. tabulettes sublinguales): 8 are relatively small and dissolve rapidly. they are placed under the tongue and allowed to dissolve after absorption, the drug enters the systemic circulation without passing through the portal circulation, thus avoiding first-pass inactivation in the liver. absorption of lipid-soluble molecules through the oral mucosa is rapid and the effect of drugs given in this way may become apparent within 2 min. Nitroglycerin and organic nitrates are commonly administered by this route. Drugs that are destroyed by the gastrointestinal fluids or are subject to substantial presystemic metabolism may be formulated into such tablets. Examples: Nitroglycerin, Methyltestosterone, Validol, etc. buccal tablets (tabulettes buccales) are small, flat, oval tablets, intended for buccal administration by inserting them into the buccal pouch (the space between the teeth and the cheek). They are dissolved or eroded slowly. Example: Desaminooxytocine (Sandopart) chewable tablets are large, hard tablets, difficult to swallow, intended to be crushed before ingesting. Example: Combantrin, Centrum junior, etc. effervescent tablets (tabulettes effervescentes) contain sodium bicarbonate and an organic acid in addition to the drug substance. In the presence of water, these additives react liberating carbon dioxide which acts as disintegrator and produces effervescence. These tablets are soluble and they are taken readily and absorbed rapidly (e.g., Upsarin, Vit C, Supradin, etc.) sugar-coated tablets (SCT, dragee, -s) are smooth, oval compressed tablets containing sugar coatings. Sugarcoating provides both protection and sweet taste but the coating operations take a long time. Example: Nifedipin, Vitaferro, etc. film-coated tablets (FCT, film-tabulettae) are compressed tablets which are covered with a thin layer or a film of polymeric substances to protect their contents from moisture or to mask the taste of the ingredients. enteric-coated tablets (ECT, tabulettes enterosolventes) are coated with substances that resist solution in gastric fluid but disintegrate in the alkaline contents of the intestine. Enteric coating is used for drugs with a gastric irritant action, for drugs which are unstable in the acid medium of the gastric contents or if the drug should act on the intestine. (e.g., Voltaren, Salazopyrin). 9 controlled-release tablets are formulated to release the drug slowly over a prolonged period of time. These dosage forms have been referred to as prolonged-release (PR) or sustained-release (SR) dosage forms as well. 2. Tablets for parenteral administration inserts are intended for insertion into body orifices. Metronidazole, Isoconazole, Clotrimazole are vaginal tablets (tabulettes vaginales). pellets (tablets for implantation) are small, sterile tablets, used by implantation when prolonged and continuous absorption is desired (Estradiol, Disulfiram, etc.) tablets for solutions are used for preparing solutions for external use CAPSULES Capsules (capsula, -ae) are solid dosage forms in which the drug substance is enclosed in either a hard or soft soluble container of suitable form of gelatin. They are intended to mask the smell and taste of the drug substance. Capsules are tasteless, easily administered and some patients prefer them to the tablets. 1. Hard gelatin capsules (capsulae gelatinosae durae s. operculatae), also referred to as dry-filled capsules (DFC), consist of two sections, one slipping over the other, thus completely surrounding the drug formulation. Commercially filled capsules have the conventional oblong shape. 2. Soft elastic capsules (SEC; capsulae gelatinosae molles s. elasticae) are soft, globular, gelatin shells somewhat thicker than that of hard gelatin. They may be round, oval, oblong, or tube-shaped and the contents may be liquid, paste, or powder. Oil-soluble drugs, (e.g. vit A, E) can be administered in SEC. 3. Enteric-coated capsules remain intact in the stomach, but dissolve and release the contents of the capsule once it reaches the small intestine. They delay the release of drugs which are inactivated by the stomach contents or may irritate the gastric mucosa. Enteric coatings are prepared of synthetic polymers. PILLS Pills (pilula, -ae) are small, round dosage forms for oral administration which are prepared by the pharmacist. They are rarely prescribed today. The powdered ingredients are mixed together with binding agents and solid extracts (excipiens, -entis) and made into a plastic mass (massa pilularum). The pill mass is rolled into spheres and coated with talc, gelatin, or sugar. TROCHES 10 Troches (lozenges or pastilles) are discoid-shaped oral forms containing a drug substance in a flavored base. They are placed in the mouth where they slowly dissolve, liberating the active ingredient. The drug involved can be antiseptic, local anesthetic, antibiotic, antitussive, or decongestant. GRANULES Granules (granulae) are dosage forms related to powders. They are particularly suitable for the preparation of solutions or mixtures of drugs, such as antibiotics, that are unstable in the presence of water. Effervescent granules contain sodium bicarbonate and citric acid or tartaric acid in addition to the active ingredients. On solution in water, carbon dioxide is released. These forms mask the unpleasant taste and ensure better absorption of the medications. PRESCRIPTION WRITING Rp./ Nitroglycerini 0,5 mg Da scatulam № 1 in linguettis Signa (Scribe). Place 1 tablet under tonge. # Rp./ Aspirni Protect 100 mg Da scatulam № 1 in tabulettis entreosoventis S. Take 1 tablet daily. # Rp./ Aspirni C Da scatulam № 1 in tabulettis effervesentibus S. Take 1 tablet 3–4 times daily, dissolved in 250 ml water. # Rp./ Tabulettarum Analfini 500 mg (Tabl. Analgini 500 mg) Da scatulam № 1. S. Take 1 tablet 3–4 times daily # Rp./ Isoptini SR 120 mg D. scat. № 1 in film-coated tablets. S. Take 1 tablet daily at 8:00 a.m. # Rp./ Аllergosani 25 mg Da scatulam № 1 in dragées. (Da scatulam № 1 in sugar-coated tablets) Signa. Take 1 tablet 3–4 times daily. 11 # Rp./ Amoxicillini 1 g D. scat. № 1 in capsulis (caps.). S.Take 1 capsules every 8 hours for 5 days. # Rp./ Pulv. Natrii hydrocarbonatis 50 g D. S. Take 1 teaspoon 1 hour after meals and bedtime. # Rp./ Codeini phosphatis 10 mg Sacchari lactatis 300 mg M. f. pulvis. D. t. d. № 20 S. Take 1 powder 3 times daily. # Rp./ Pulveris dermatici Topocini 5 g (Pulv. derm. Topocini 5 g) D. scat. № 1. S. For external application. # Rp/ Flac. Zinnati 125 mg/5 ml – 60 ml (Granulorum Zinnati 125 mg/5 ml – 60 ml) (Suspensionis Zinnati 125 mg/5 ml – 60 ml) Da. Signa. 2 ml every 12 hours (for baby with body mass 10 kg) LIQUID DOSAGE FORMS I. DEFINITION OF LIQUID DOSAGE FORMS Liquid dosage forms are prepared by dissolving the active ingredient(s) in an aqueous or nonaqueous solvent, by suspending the drug in appropriate medium or by incorporating the drug substance into one or two phases of an oil and water system. These forms can be formulated for different routes of administration: oral use, introduction into body cavities , or applied externally. The oral liquid forms can be readily administered to children or people unable to swallow tablets or capsules. The absorption rate of oral dosage forms decreases in the following order: aqueous solution > aqueous suspension > tablet or capsule. Drug substances are less stable in aqueous media, than in the solid 12 dosage forms and it is important to properly stabilize and preserve them. There is a risk of chemical interactions and microbial contamination for some of the products. II. CLASSIFICATION OF LIQUID DOSAGE FORMS 1. Solutions (solutio, – onis, -ones) aqueous solutions nonaqueous solutions 2. Emulsions (emulsio, -onis, -ones) 3. Suspensions (suspensio, -onis, -ones) 4. Mucilages (mucilago, -inis, -ines) 5. Liniments (linimentum, -i, -a) 6. Infusions and decoctions (infusum, -i; decoctum, -i) 7. Drops (guttae, -arum) 8. Mixtures (mixtura, -ae, -ae) 9. Sterile dosage forms for injection ampoules (ampulla, -ae) vials (flacon, -is) bottles (olla, -s) prefilled disposable syringes (or pre-filled syringes) II. CHARACTERISTICS OF LIQUID DOSAGE FORMS SOLUTIONS Solutions (solutio, -onis, -ones) are homogeneous mixtures that are prepared by dissolving a solid, liquid, or gas in another liquid. The molecules of the dissolved substance are dispersed among those of the solvent. Many pharmaceuticals are simply solutions of a medicament in water, alcohol, ether, glycerin, oils, or some other solvent. Various aromatic waters (e.g., chloroform or peppermint water) may also be used as solvents. Solutions are intended for internal, external, and parenteral administration. 1. Aqueous solutions include those pharmaceutical forms that are prepared with purified water (aqua destillata – deionized, demineralized water) or aromatic water as a solvent. Simple solutions for oral administration, douches, enemas, gargles, mouthwashes, nasal and otic solutions are assigned to this category. 2. Nonaqueous solutions are the alcoholic and hydroalcoholic solutions, ethereal solutions, glycerin solutions, etc. 13 Solutions may be prepared in bulk or as single-use packages, and they are usually bottled automatically (few of them can be prepared extemporally). EMULSIONS Emulsions (emulsio, -onis, -ones) are two-phase systems in which one liquid is dispersed throughout another liquid in the form of small droplets. They are classified as: oil-in-water (O/W) emulsion – oil is the dispersed phase and an aqueous solution is the continuous phase water-in-oil (W/O) emulsion – an aqueous solution is the dispersed phase and oil is the continuous phase These forms can be administered orally, topically, or parenterally (intramuscularly). Specialized uses include emulsions for intravenous feeding of lipid nutrients (Intralipid). Other radiopaque emulsions are used as diagnostic agents for X-ray examinations. Emulsions are thermodynamically unstable. They appear white and tend to separate on standing. In order to prepare suitable emulsions and to have them remain stable for a suitable period of time, a number of emulsifying agents are used in their preparation. They can be natural substances (acacia or Gumma arabicum, tragacanth, pectin, gelatin, egg yolk, lecithin, etc.), finely divided solids, or synthetic agents. SUSPENSIONS Suspensions (suspensio, -onis, -ones) are two-phase systems consisting of a finely divided solids dispersed in liquids. If the drug is insoluble or poorly soluble, a suspension may be the most suitable dosage form. The taste of drugs can be improved if they are supplied in suspension form rather than solutions. Suspensions may be formulated for oral, parenteral (intramuscular or intraarticular) or topical administration. Antibiotic granules are generally used for preparation of suspensions in pediatric practice. Well formulated suspensions should posses certain basic properties. The dispersed phase should settle slowly, if at all possible, and be dispersed readily on shaking. The main ingredients in a suspension are: a drug natural viscosity agents (natural gums and cellulose derivatives) 14 an external medium – it is usually water for oral preparations; or other polar liquids (glycerin, alcohol) MUCILAGES Mucilages (mucilago, -inis, -ines) are thick, viscid, adhesive liquids, produced by dispersing gum in water, or by extracting the mucilaginous principles from plant substances with water (Gumma arabicum, Radix althaeae, etc.). They are unstable and should never be made in quantities larger than those that can be used immediately, unless a preservative is added. Mucilages are used primarily to prevent immediate sedimentation of insoluble substances in liquids. They can prevent mucous irritation caused by some drug substances (e.g., Chlorali hydras). INFUSIONS AND DECOCTIONS Infusion (infusum, -i, -a) is a dilute solution of the readily soluble constituents of crude drugs (from the soft parts of plants). Fresh infusions are prepared by macerating the drugs for a short period of time (15 min) with boiling water. Decoction (decoctum, -i, -a) are extracts of the water-soluble and heat-stable constituents from crude drugs (from the hard parts of plants) by boiling in water for 30 min, and cooling. These forms are of short duration and should never be administered in quantity for more than 3 days. DROPS Drops (guttae, -arum) are solutions, tinctures, or mixtures of highpotent drug substances. These forms are intended to be administered internally or externally (as eye drops or collyrium, nasal, and otic drops). Drops are prescribed in small quantity (10 – 30 g). For officinal forms, the right number of drops per 1 ml of liquid have to be labeled. MIXTURES 15 Mixtures (mixtura, -ae, -ae) are multicomponent liquid containing two or more active ingredients, dissolved, suspended, or dispersed in a suitable liquid base (water, alcohol, glycerin, aromatic water, or infusions and decoctions). Some mixtures may contain tinctures. Suspended solids may separate slowly on standing, but are easily redispersed on shaking (shake mixtures – mixturae agitandae).Syrups are added as Remedium corrigens, in quantity of 20% of the total volume (30% for children). Mixtures are unstable dosage forms with short duration and they are subject to contamination by microorganisms during the period of their use. STERILE DOSAGE FORMS FOR INJECTION Sterile dosage forms for injection differ from all other drug dosage forms because of their unique use for injection directly into body tissue through the primary protective systems of the human body, the skin and mucous membranes. Therefore, they must be exceptionally pure and free from contaminants. Injections may be classified in several categories: 1. Solutions ready for injection 2. Dry, soluble products ready to be combined with a solvent just prior to administration (ex tempore) 3. Suspensions ready for injections 4. Emulsions 5. Liquid concentrates ready for dilution prior to administration These injections may be administered by such routes as intravenous, subcutaneous, intradermal, intramuscular, intraarticular, and intrathecal. The nature of the product will determine the route of administration. Suspensions would not be administered directly into the blood stream because of the danger of insoluble particles blocking capillaries. Unstable emulsions, if injected intravenously may cause lipid embolism (excluding some forms with special characteristics). Hypertonic solutions are administered only intravenously. When compared with other dosage forms, injections possess certain advantages: 1. They provide drugs for immediate action 2. The therapeutic dose is adjusted more accurately and readily 3. Drugs can be administered parenterally in cases of unconscious or uncooperative state of the patient, or because of lack of absorption from the GIT. Among the disadvantages are requirement of asepsis, pain factor, risk of local irritation, difficulty in correcting the error. 16 Parenteral products are packaged in ampoules, vials, bottles, plastic bags, and prefilled disposable syringes. Containers for injections can be made of glass or thermoplastic polymers. They may range in size from 1000 ml bottles to 1 ml or less ampoules, vials, or syringes. Each vial is sealed with a rubber closure held in place by an aluminum cap. The most widely used solvent for parenteral preparations is sterile water for injection (aqua redestillata or bidestillata – pyrified water rendered sterile and pyrogen-free by repeated distillation). Other common solvents include sodium chloride injection, peach oil (for water-insoluble drugs), etc. PRESCRIPTION WRITING Rp./ Sol. Natrii citratis 4% 150 ml D. S.Take 1 tablespoon 3 times daily. # Rp./ Pulv. Natrii citratis 6 g Aquae destillatae ad 150 ml Misce. Da. Signa.Take 1 tablespoon 3 times daily. # Rp./ Infusi radicis Primulae 6 g/180 g Ephedrini hydrochloridi 300 mg Liquoris Ammonii anisati Natrii benzoatis aa 3 g M. f. mixtura. D. S. Take one tablespoon 3 times daily. # Rp./ Tincturae Valerianae 20 g (T-rae Valerianae 20 g ) D. S. Take 20 drops 3 times daily. # Rp./ Solutionis Xylometazolini 0,1% 10 ml (Sol. Xylometazolini 0,1% 10 ml) D. t. d. № 1 in flaconis (fl.). S. Put 2 drops into nose 3 times daily. # Rp./ Penicillini G 1 000 000 IU (Benzylpenicillini 1 000 000 IU) D. t. d. № 20 in fl. S. 500 000 IU i.m. every 8 hours (after dissolving in 5 ml distilled water). # Rp./ Solutionis Lydoli 5% 2 ml 17 (Sol. Pethidini 100 mg/2 ml) Da tales doses № 10 in ampullis. Signa. 2 ml every 6 hours i.m. (on the yellow prescription form) # Rp./ Sol. Diazepami 10 mg/2 ml D. t. d. № 5 in amp. S. 1 or 2 ml intravenously slowly (5 min) diluted with 20 or 40 ml 40% glucose. (on the green prescription form) # Rp./ Fraxiparini 0.3 ml (Nadroparini 0.3 ml) D. t. d. № 10 in pre-filled syringes. S. 0.3 ml per day subcutaneously in the area of the navel for 7–14 days. SEMISOLID DOSAGE FORMS Semisolid dosage forms include ointments, liniments, gels, suppositories, plasters, and plaques. I. CLASSIFICATION OF SEMISOLID DOSAGE FORMS 1. Ointments (unguentum, -i, -a) ointments (unguentum, -i, -a) creams (creme, -ores) pastes (pasta, -ae, -ae) 2. Gels (gel, -i) 3. Liniments (linimentum, -i, -a) 4. Suppositories (supositorium, -i, -a) rectal suppositories (suppositoria rectalia) vaginal suppositories (suppositoria vaginalia) urethral suppositories (suppositoria urethralia) 5. Plasters medicated plasters (emplastrum, -i, -a) 18 transdermal delivery systems (TTS) 6. Plaques II. CHARACTERISTICS OF SEMISOLID DOSAGE FORMS OINTMENTS (unguentum, -i, -a) are semisolid preparations intended for external application to the skin or mucous membranes; usually, but not always, they contain medicinal substances. The types of ointment bases used as vehicles (vehiculum, basis unguenti) are selected for optimum delivery of the drug. Ointment properties vary, since they are designed for specific use, ease of application, or extent of application. Oleaginous bases are described as ointments, emulsion bases may be termed creams, and the forms containing large amounts of solids are termed pastes. Ointment bases (vehiculum, basis unguenti) should be nonirritating, easily removable, nonstaining, stable, non-pH-dependent and widely compatible with a variety of medicaments. They are categorized into four classes: 1. Oleaginous bases: vegetable fixed oils: olive oil, almond oil, sunflower oil; animal fats; minerals:Vaseline (vaselinum), and paraffin (hard paraffin, paraffinum solidum; liquid paraffin, paraffinum liquidum). Bases of this type are occlusive, nearly anhydrous and provide an optimum stability for medicaments. 2. Absorption bases: anhydrous lanolin (lanolinum anhydricum, sheeps wool fat). It contains not more than 0,25% of water. It is suitable whenever a large volume of aqueous solutions must be incorporated into the ointment. Lanolin (lanolinum) – anhydrous lanolin is converted to lanolin by the addition of 30% water. It is good emollient and protectant. 3. Emulsion bases: most commonly used type of ointment bases. The oil phase is typically made up of Vaselinum and/or liquid petrolatum (Paraffinum liqidum). 4. Water-soluble bases – they are generally prepared of polyethylene glycol. TYPES OF OINTMENTS: 1. OINTMENTS (UNGUENTUM, -I, -A) are prepared of solid active ingredients (1–25%), finely powdered and then incorporated into the oleaginous base. According to the way of administration they can be: 19 ointments for skin application (unguenta dermatica: 20–100 g), eye ointments (unguenta ophthalmica: 3–10 g), nose ointments (unguenta nasalia), etc. 2. PASTES (PASTA, -AE, -AE) contain powders dispersed in the vehicle in quantity more than 25%. They are usually stiffer, less greasy and more absorptive than ointments. Pastes adhere reasonably well to the skin and they are suited for application on and around moist lesions. Pastes are less macerating than ointments. They easily may be removed from the skin. They are divided into pastes for application on the skin (pastae dermaticae) and dental pastes (pastae dentifricae). An official paste is the Zinc Oxide paste. 3. CREAMS (CREME, -ORES) are similar to ointments but they contain a water phase (water, aromatic water, etc.). They are classified as: cold creams with roughly dispersed water phase and cooling properties emollient creams with finely dispersed water phase, which soften the skin. 4. GELS or jellies (gel, -i) are semisolid dosage forms with high degree of clarity, ease of application and ease of removal and use. The active ingredients are incorporated into water-soluble bases. The gels often provide a faster release of drug substance as compared to creams and ointments. Gel formulations include ophthalmic preparations of pilocarpine, carbachol; topical preparations for burn therapy; anti-inflammatory treatment; treatment of acne, etc. Depending on their ingredients some gels may function as protective coatings. Gels are prepared in adhesive forms in order to increase the contact time of the active ingredients, e.g., topical dosage forms for aphthous stomatitis. LINIMENTS Liniments (linimentum, -i, -a) are thick, viscid liquids, emulsions, suspensions, etc. They are intended for external application. They usually are applied with friction and rubbing onto the affected area. The oily liniments are milder in their action but are more useful when massage is required. SUPPOSITORIES Suppositories (suppositorium, -i, -a) are solid dosage forms of various weights and shapes for insertion into the rectum, vagina, or the urethra. After insertion, suppositories soften, melt, and dissolve in the cavity fluids. Suppository vehicles (bases) can be classified into two types: fatty (e.g., Cocoa butter) and water soluble (e.g., polyethylene glycol). Cocoa butter is a naturally occurring triglyceride, being solid at room temperature and melting quickly at body temperature. 20 Types: (1) Rectal suppositories (suppositoria rectalia) are administered rectally either to treat local conditions such as hemorrhoids or to achieve systemic absorption (sedatives, tranquilizers, and analgesics). Rectal suppositories can be used when the patient is enable to take medication by mouth, or when the patient is unconscious. The lower, middle and upper hemorrhoidal veins surround the rectum. Only the upper vein conveys blood into the portal system, thus drugs absorbed into the lower and middle hemorrhoidal veins will bypass the liver. Disadvantages to the use of rectal suppositories include possible uncertain, local irritation and possible accidental loss of the medication. (2) Vaginal suppositories are applied vaginally for a local effect. Following intravaginal administration, some drug absorbtion from the intact vaginal mucosa is likely. (3) Urethral suppositories (suppositoria urethralia) are cylindrical dosage forms, administered urethrally to treat local conditions. They are unusual dosage forms. PLASTERS Plasters (emplastrum, -i, -a) are substances intended for external application made of such materials and of such consistency as to adhere to the skin. They are intended to protection and support and/or to bring medication into close contact with the skin. adhesive plasters medicated plasters are used for local or regional drug delivery transdermal delivery (or therapeutic) systems (TTS) are used for longterm systemic delivery of therapeutic agents through the skin (e.g., antihypertensive, antianginal, analgesic, steroidal and contraceptive drugs). Examples: Nitroderm TTS, Estraderm TTS, Durogesic, etc. PLAQUES Plaques are special devices for local controlled, prolonged drug therapy, which are intended for application under the eyelid or in the conjunctival sac of the eye (plaques used in the treatment of glaucoma) or on the palate (plaques with antifungal action). AEROSOLS (SPRAY) These drugs are designed to carry the drug into the respiratory tree of the patient or on the skin and mucous (nasal, etc.). According to the chemical 21 characteristics, they are categorized in three groups: gases (nitrous oxide, oxygen), vapors of volatile liquids (ether, halothane, chloroform), and aerosols (sprays). Aerosols are heterogeneous systems consisting of very finely subdivided liquid or solid particles (optimum size 0,5–3 μm) dispersed in a gas medium. The pressurized aerosol packages contain different propellants (compressed gases) driving the drug in the form of mist or foam. They can be inhaled (nasally or orally) or applied topically to dispense a variety of agents for treatment of systemic and topical diseases. Metered dose inhalers (with a metering valve) contain multiple doses and they are intended for delivering measured quantities of drug. Examples: Salbutamol, Salmeterol, Fenoterol, etc. Powders may be administered by mechanical devices that require manually produced pressure and a deep inhalation by the patient (e.g., Cromolin sodium). Nebulizers are devices used for administration of solutions giving sufficiently small droplets. Nebulised solutions may be breathed directly or by a plastic face mask or a tent. Advantages: rapid onset of action; bypass the hepatic circulation; avoidance of degradation in the gastrointestinal tract; lower dosage that minimizes adverse reactions; simple, convenient and acceptable therapy. PRESCRIPTION WRITING 1. Ointments Rp./ Acidi borici 1,0 Vaselini albi ad 20,0 Msce fiat unguentum. D. S. Apply twice daily to the affected skin. Not for children under 3 years. # Rp./ Unguenti dermatici Acidi borici 5% 18,0 D. tub. № 1. S. Apply twice daily to the affected skin. Not for children under 3 years. # Rp./ Ung. derm. Gentamycini 0,1% 15,0 D. tub. № 1. S. Apply twice daily to affected skin. # Rp./ Unguenti ophthalmici Gentamycini 0,3% 5,0 22 (Ung. Ophth.) Gentamycini 0,3% 5,0 D. tub. № 1. S. Apply in the lower conjunctival sac of the affected eye twice daily. # Rp./ Ultraproct 15,0 (Ultraproct 15 g) D. tub. № 1. S. Apply rectally in the evening. 2. Pastes Rp./ Acidi salicylici 2,0 Zinci oxydi 25,0 Vaselini 48,0 M. f. pasta. D. S. Apply externally to the burned area once daily. # Rp./ Pastae Zinci 25,0 D. tub. № 1. S. Apply externally to the burned areas once daily. 3. Gels Rp./ Geli Troxevasini 2 % 40,0 D. tub. № 1 S. Apply twice daily to the affected area (for treatment of varices). 4. Creams Rp./ Creme Clotrimazoli 1% 20,0 D. tub. № 1. S. Apply externally to the affected area. 5. Liniments Rp./ Olei Lini Aquae Calcis aa 50,0 M. f. linimentum. D. S. Apply to the burned area. 6. Suppositories Rp./ Paracetamoli 150 mg (Paracetamoli 0,150) D. scat. № 1 in supp. S. Insert 1 suppository into rectum twice daily. 23 # Rp./ Morphini hydrochlorici 0,01 Butyri Cacao q. s. M. f. supp. D. t. d. № 3. S. Insert 1 supp. into rectum in case of pain. # Rp./ Doloproct D. scat. № 1 in supp. S. Insert 1 supp. into rectum in the evening. 7. Plasters Rp./ Nitrodermi TTS 25 mg D. scat. № 1 S. Stick 1 plaster daily on the precordial area. 8. Aerosols Rp./ Ventolini inhaler 0,1 mg D. t. d. № 1 in flac. S. For inhalation in case of asthma attack. # Rp./ Bicromati 20,0 D. scat. №1 in caps. S. Inhale 2 capsules every 12 hours, with spinhaler. EXTEMPORANEOUS PRESCRIPTIONS 1. Antacid powder with anaesthesine (benzocaine) Rp./ Anaesthesini Bismuthi subnitratis aa 3,0 Magnesiae oxydi 40,0 M. f. pulvis. D.S. Half a teaspoon to be taken with meal. 2. Powder with caffeine for general refreshment Rp./ Coffeini puri 0,05 Sacchari albi 0,2 M. f. pulvis D. t. d. № 20 S. Take one powder each morning and at lunch-time. 24 3. Bourget powder with antiacid action Rp./ Natrii bicarbonatis 8,0 Natrii phosphatis 4,0 Natrii sulfatis 2,0 M. f. pulv. D. t. d. № 10 S. 1 powder to be dissolved in 1 l of water. Drink 1 tea-cup half an hour before meal. 4. Emulsion with laxative action Rp./ Olei Ricini 20,0 Gummi arabici 10,0 Aquae destillatae ad 200,0 M. f. emulsion. D. S. To be taken all at once. 5. Spasmolytic drops with atropine (for 7 days) Rp./ Atropini sulfatis 0,01 Aquae destillatae ad 20,0 M. D. S. Take 20 drops 3 times daily. 6. Eye drops with Pilocarpine Rp./ Sol. Pilocarpini hydrochloridi 2% 10 ml D. t. d. № 1 in flac. S. Place 1 drops in each eye 3 times daily. 7. Drops for treatment of abdominal colics Rp./ Dionini (Aehylmorphini) Papaverini hydrochlorici Extr. Belladonnae aa 0,2 Aquae Laurocerasi 20,0 M. D. S. Take 20 drops 3 times daily. 8. Mixtura nervina (for 7 days) Rp./ Natrii bromatis Kalii bromatis aa 6,0 T-rae Valerianae T-rae Adonidis vernalis aa 10,0 Coffeini-Natrii benzoatis 1,0 Phenobarbitali-Natrii 0,6 Sirupi Menthae 60,0 25 Aquae destillatae ad 200,0 M. D. S. Take 1 tablespoon 3 times daily, after meals. 9. Suppositories with morphine (with systemic action) Rp./ Morphini hydrochloridi 0,01 Butyri Cacao q. s. M. f. supp. D. t. d. № 6. S. Insert 1 supp. into rectum in case of pain. 10. Liniment for treatment of burning Rp./ Olei Lini Aquae Calcis aa 50,0 M. f. linimentum. D. S. Apply to the burned area. 26