Recall of substandard medicines in Brazil during the period 2010-2018.

BACKGROUND: Even with all the care taken during the production process, the pharmaceutical industries are still subject to manufacturing medicines with quality deviations, generating commercialized products without the required quality and necessitating their subsequent recall from the market. The objective of this study was to evaluate the reasons that led to the recall of medicines in Brazil in the period evaluated. METHODS: This is a descriptive study (using document analysis), on the recall of substandard medicines registered on the website of the National Health Surveillance Agency (ANVISA), from 2010 to 2018. The variables studied were the type of medicine (reference, generic, similar, specific, biological, herbal, simplified notification, new and radiopharmaceutical), type of pharmaceutical dosage form (solid, liquid, semi-solid and parenteral preparation), and reason for recall (Good manufacturing practices, quality and quality/good manufacturing practices). RESULTS: A total of n = 3,056 recalls of substandard medicine were recorded. Similar medicines had a higher recall index (30.1%), followed by generics (21.3%), simplified notification (20.7%) and reference (12.2%). Different dosage forms had similar recalls: solids (35.2%), liquids (31.2%) and parenteral preparations (30.0%), with the exception of semi-solids (3.4%). The reasons for the highest occurrences were related to good manufacturing practices (58.4%) and quality (40.4%). CONCLUSION: The probable cause for this high number of recalls is the fact that, even with all the quality controls and processes in accordance with good manufacturing practices, errors can occur, both human and in automated processes, thus causing the release of batches that should not have been approved. In summary, it is necessary for manufacturers to implement a robust and well structured quality system in order to avoid such deviations, and it is up to ANVISA to apply greater oversight in the post marketing of these products.

Pentacyclic triterpene-loaded emulsion stabilized by Agaricus blazei Murill polysaccharides: Factorial design and cytoprotection study.

In this study, pentacyclic triterpene-loaded emulsions were stabilized by polysaccharides from Agaricus blazei Murill mushroom (PAb). The drug-excipient compatibility results by Fourier Transform Infrared Spectroscopy (FTIR) and Differential Scanning Calorimetry (DSC) showed the absence of physicochemical incompatibilities. The use of these biopolymers at 0.75 % led to obtaining emulsions with droplets smaller than 300 nm, moderate polydispersity, and ζ-potential >30 mV in modulus. The emulsions presented high encapsulation efficiency, suitable pH for topical application, and absence of macroscopic signs of instability during 45 days. Morphological analysis suggested the deposition of thin layers of PAb around the droplets. The encapsulation of pentacyclic triterpene in emulsions, stabilized by PAb, improved the cytocompatibility of this drug against PC12 and murine astrocyte cells. There was a reduction in cytotoxicity, which resulted in a lower accumulation of intracellular reactive oxygen species and maintenance of the mitochondrial transmembrane potential. Based on these results, it is estimated that PAb are promising biopolymers for the emulsions' stabilization by improving their physicochemical and biological properties.

Drugs via enteral feeding tubes in inpatients: dispersion analysis and safe use of dispensers.

OBJECTIVE: This study aimed to improve knowledge about drug administration through enteral feeding tubes (EFTs) in order to minimize efficacy and safety problems. MATERIAL AND METHODS: The study was performed in a public secondary care hospital with level II accreditation by the National Accreditation Organization (Organização Nacional de Acreditação ONA), in Fortaleza, Ceará, north-eastern Brazil. RESULTS: One hundred and eight oral solid medications that could be administered through EFTs and were not available in liquid forms were evaluated via transformation of their solid dosage forms into liquid forms. Dispersion times and conditions were assessed to determine which medications should be crushed. We compared the use of dispensers and syringes and their connections to enteral feeding tubes and intravenous devices. Medications whose dispersion occurred within 20 minutes and could be visually perceived and whose content could be expelled without occluding the oral syringe were considered "satisfactory". CONCLUSIONS: The dispersion was "satisfactory" in 82 (75.9%) of the medications; they were classified as capable of being dispersed in water in the oral syringe for further administration via EFTs without the need for crushing. Use the dispenser instead of the syringe for drug administration was safer because the dispenser apparatus did not fit into equipment for intravenous drug administration.

Stability-indicating capillary zone electrophoresis assay for the analysis of linezolid in tablets

A simple and fast alternative methodology using capillary zone electrophoresis (CZE) to analyze linezolid and its cationic photodegradation products in tablets has been developed. The separation was carried out on fused silica capillary and conducted using 100 mM formic acid (pH 3.0) and by applying 30 KV voltage. Detection was performed at UV 254 nm. The optimized method was validated in terms of linearity, limits of detection and quantification, precision (repeatability), stability studies (selectivity) and accuracy. Good linearity (8-20 mg L-1) was obtained and the limit of detection was 0.95 mg L-1. The greatest advantages of the CZE method were the rapid set-up of instrumentation and capillary equilibration, short analysis time (12 min), low running cost and low waste generation. The method showed good stability in determining linezolid submitted to degradation by light and to a climatic chamber and can be used as an alternative for evaluation in stability studies of linezolid in tablets, as well as for the analysis of the drug in raw materials and finished products.