Existing and emerging mitigation strategies for the prevention of accidental overdose from oral pharmaceutical products.

Misadventure with pharmaceutical oral medication has been on the rise, with the opioid crisis playing a major part. Drug overdose related to opioids has become such an issue, that it has been labelled a worldwide crisis. This review explores the mitigation strategies currently in place to prevent accidental overdose from oral pharmaceuticals, categorising the options based on whether they are relevant before, during or after the consumption of a toxic drug dose. To prophylactically prevent an overdose before consumption, governments and medical boards provide guidelines and implement policy, such as prescription monitoring, for the use of heavily abused medication. Some opioids have also been formulated as abuse deterrent formulations (ADF) which make it difficult for an individual to tamper with the medication. However, this does not prevent accidental overdose and only a few novel formulations were found to have multi-dose preventative properties. After an overdose has occurred, the situation is usually dealt with by first responders and hospitals using antidotes or medical procedures to limit the absorption of the drug. As pharmaceutical scientists, therein lies an opportunity to produce novel formulations that could limit the chances of accidental overdose. One approach could be to harness the physiological properties within the gastrointestinal tract (GIT), especially the enzymatic degradation of macromolecular matrix formulations. The ideal formulation will deliver a therapeutic dose but prevent or limit further release from consequent dose forms if a toxic quantity of drug is consumed.

Controlling drug release by introducing lipase inhibitor within a lipid formulation.

Drug overdose connected to marketed pharmaceutical products, particularly opioids, occurs at an alarming rate. Novel strategies through innovative formulation approaches that reduce the likelihood of overdose while allowing safe therapeutic outcomes are urgently required. The current study provides a proof-of-concept for a new formulation approach by co-formulating drug with a lipase inhibitor within a solid lipid formulation in order to prevent or reduce the harmful effects of taking multiple doses of an oral solid dose form. Lipase inhibitor controlled-release (LICR) formulations were created using a simple hot melt method to co-formulate the inhibitor (orlistat) and ibuprofen, as the model drug, within the lipid matrix. The digestion and drug release kinetics were determined using an in vitro lipolysis model. Above a threshold level of orlistat there was decreased digestibility of multiple doses of the LICR formulations, leading to reduced drug release. Upon administration of the formulations in capsules to rats, the LICR formulation displayed the lowest exposure of ibuprofen during the pharmacokinetic studies. This novel formulation approach shows promise in preventing accidental drug overdose after oral administration of multiple doses of formulation.

Impact of Ferroquine on the Solubilization of Artefenomel (OZ439) during in Vitro Lipolysis in Milk and Implications for Oral Combination Therapy for Malaria.

Milk is an attractive lipid-based formulation for the delivery of poorly water-soluble drugs to pediatric populations. We recently observed that solubilization of artefenomel (OZ439) during in vitro intestinal lipolysis was driven by digestion of triglycerides in full-cream bovine milk, reflecting the ability of milk to act as an enabling formulation in the clinic. However, when OZ439 was co-administered with a second antimalarial drug, ferroquine (FQ) the exposure of OZ439 was reduced. The current study therefore aimed to understand the impact of the presence of FQ on the solubilization of OZ439 in milk during in vitro intestinal digestion. Synchrotron small-angle X-ray scattering was used for in situ monitoring of drug solubilization (inferred via decreases in the intensity of drug diffraction peaks) and polymorphic transformations that occurred during the course of digestion. Quantification of the amount of each drug solubilized over time and analysis of their distributions across the separated phases of digested milk were determined using high-performance liquid chromatography. The results show that FQ reduced the solubilization of OZ439 during milk digestion, which may be due to competitive binding of FQ to the digested milk products. Interactions between the protonated FQ-H+ and ionized liberated free fatty acids resulted in the formation of amorphous salts, which removes the low-energy crystalline state as a barrier to dissolution of FQ, while inhibiting the solubilization of OZ439. We conclude that although milk could enhance the solubilization of poorly water-soluble OZ439 during in vitro digestion principally due to the formation of fatty acids, the solubilization efficiency was reduced by the presence of FQ by competition for the available fatty acids. Assessment of the solubilization of both drugs during digestion of fixed-dose combination lipid formulations (such as milk) is important and may rationalize changes in bioavailability when compared to that of the individual drugs in the same formulation.