[Modern extemporaneous formulations in the geriatric care management: current opportunities and future challenges. A review].

Age-associated disorders, including cognitive functions, that often occur in geriatric patients, necessitate the use of novel approaches to provide appropriate medical care, pharmacoprophylaxis and pharmacotherapy among them. At the same time, an important objective of the national healthcare system is not only stimulating of pharmaceutical companies and pharmacies to expand the range of medicines intended for elderly patients, but also increasing availability of medicinal products, including the integration of extemporaneous formulations into clinical practice. Presented review considers several features of the regulation of the use of extemporaneous formulations in the treatment of geriatric patients. Examples of prescriptions that are used in Russian medical practice and are of the greatest interest in the treatment of elderly patients are also presented.

[Pediatric dermatology-What to consider in prescriptions?] / Kinderdermatologie ­ Was ist beim Rezeptieren zu beachten?

In recent years, patient management in the area of dermatolgogical diseases has changed considerably in both adults and children. In addition to well-established topical treatment, new systemic treatment approaches have emerged. Topical treatments are still in the forefront in the management of pediatric patients with dermatological diseases. In addition, formulations are therapeutic options that enable us to increase the treatment possibilities due to the fact that we can change concentrations of ingredients, implement new findings from clinical research and/or prescribe large amounts of topical basic therapy. Extemporaneous formulations should be preferred to individual preparations.

[New developments in extemporaneous formulations]. / Neue Entwicklungen der Magistralrezepturen.

Dermatology is in a state of flux, and systemic therapies have changed the prescription practice in the past few years. Nevertheless, topical therapy for dermatological illnesses is still the mainstay of dermatologists. Pharmaceutically manufactured drugs have a wide spectrum and allow for variability. Additionally, there are therapeutic niches that can be bridged by prescribing extemporaneous formulations. This is also true for the newly established basic therapies for many chronic dermatological illnesses which have become essential and are needed in large amounts. Unfortunately, neither during medical school, nor during residency training, not even the basic knowledge or the complexity of these extemporaneous formulations for topical therapy in dermatology is taught. This emphasizes why standardized, proven extemporaneous formulations are vital for physicians to achieve optimal and goal-oriented therapy for their patients. Sensible and effective prescriptions enhance the quality of formulations and the maintenance and well-being of our patients.

Quality and stability of oral extemporaneous formulations developed from commercial tablets containing spironolactone / Desenvolvimento e estudo de estabilidade de formulações extemporâneas de uso oral a partir de comprimidos comerciais contendo espironolactona

The purpose of this study was to develop extemporaneous liquid pharmaceutical formulations from commercial tablets containing spironolactone and to assess their stability for use in children or adults with difficulty in swallowing. The content and stability of spironolactone in the tablets, as well as in water, 1.5% carboxymethylcellulose (CMC) or simple syrup dispersions were determined by high performance liquid chromatography (HPLC) analysis on a C18 silica column (250 mm ? 4.6 mm ? 5 ?m), with a mobile phase of methanol:water (75:25 v/v), flowing at 1 mL/min, and UV detection at 240 nm. The extemporaneous formulations were tested over a 35-day period at 8, 27, and 40 ºC. Drug content in the aqueous dispersion was far lower than expected, with significant fluctuations at all temperatures, owing to rapid sedimentation. The content proved adequate in aqueous 1.5% CMC dispersion at 27 ºC, with undesirable variations at the other temperatures. The syrup-based dispersion remained stable at all three temperatures, with suitable drug content and no significant variability. No degradation products were observed in any of the formulations. The syrup-based dispersion is easy to prepare, self-preserving, stable, palatable, offering satisfactory drug content per dose, and can therefore be recommended as an extemporaneous formulation for enhancing treatment adherence and effectiveness...

O objetivo desse trabalho foi desenvolver e avaliar a estabilidade de formas farmacêuticas líquidas extemporâneas, a partir de amostras comerciais (comprimidos), contendo espironolactona, para que possam ser empregadas em pacientes pediátricos ou adultos com dificuldade de deglutição. A metodologia empregada para a análise do teor e da estabilidade do fármaco espironolactona nos comprimidos e nas dispersões utilizando água, carboximetilcelulose (CMC) 1,5% e xarope simples foi a Cromatografia Líquida de Alta Eficiência (CLAE), utilizando coluna de sílica C18 (250 mm x 4,6 mm x 5 μm), fluxo de 1 mL/min, comprimento de onda 240 nm e fase móvel metanol:água (75:25 v/v). As formulações extemporâneas foram analisadas durante 35 dias nas temperaturas de 8, 27 e 40 ºC. A dispersão aquosa apresentou teor muito abaixo do esperado, com variações significativas em todas as temperaturas, devido à rápida sedimentação. A dispersão aquosa de CMC 1,5% apresentou teor adequado na temperatura de 27 ºC com variações indesejadas nas demais temperaturas. A dispersão de xarope simples apresentou-se estável nas três temperaturas, com teor adequado e sem variações significativas. Não foi observado produto de degradação em nenhuma das formulações propostas. Por ser de fácil preparação, autoconservante, estável e de sabor agradável, a dispersão de xarope simples é a formulação extemporânea recomendada, pois garante teor satisfatório por dose e, portanto, favorece aumento à adesão e à eficácia do tratamento...

Elaboração e avaliação de material educativo impresso para auxiliar na adesão medicamentosa de pacientes pediátricos pós-alta hospitalar / Development and evaluation of printed educational material to improve the medication compliance of pediatric patients after hospital discharge

O uso frequente de medicamentos off-label ou não licenciados na área da pediatria é um problema mundial que ocorre devido à indisponibilidade de formas farmacêuticas adequadas com dosagens apropriadas para a administração em crianças. Durante a internação, tal dificuldade pode ser contornada a partir da derivação de formas farmacêuticas sólidas, originando as chamadas preparações líquidas extemporâneas. Porém, para garantir o uso dos medicamentos após a alta hospitalar mesmo quando a família não pode pagar a manipulação destes, faz-se necessária uma orientação adequada de como realizar a derivação em casa pelo próprio cuidador do paciente. Objetivos: elaborar e avaliar um material educativo impresso (MEI) para auxiliar na preparação de medicamentos extemporâneos pós-alta hospitalar em pediatria. Métodos: Foi elaborada uma primeira versão de MEI e avaliada por 26 profissionais da saúde por meio do instrumento EVALPEM (Evaluation of Printed Education Materials) modificado. A partir das contribuições dos profissionais foi elaborada uma segunda versão avaliada por 5 cuidadores de crianças utilizando-se o questionário adaptado de Doak. Resultados: a primeira versão do MEI foi bem aceita pela maioria dos profissionais, onde 80,8% dos participantes consideraram as informações como sendo de qualidade e 87,5% concordaram totalmente com o domínio, legibilidade e características de impressão. A segunda versão obteve 89,1% no domínio compreensão, 90,6% em autoeficácia e 100% em atratividade, aceitação cultural e persuasão. Conclusões: o MEI demonstrou ser uma ferramenta importante para orientar o preparo

The frequent use of non-licensed or off-label drugs in pediatrics is a world problem that occurs due to the unavailability of appropriate pharmaceutical forms with proper doses to administration in children. During hospitalization, this difficulty can be avoided with the derivation of solid pharmaceutical forms, originating the so-called extemporaneous liquid preparations. Nevertheless, to guarantee the use of medication after hospital discharge – especially when the family cannot pay for its manipulation –, it is necessary to provide appropriate guidance to caregivers on how to prepare the derivation at home. Aim: to create and evaluate printed educational material (PEM) to help in the preparation of extemporaneous formulations after hospital discharge in pediatrics. Methods: a first version of the PEM was created and evaluated by 26 health workers, using the instrument EVALPEM (Evaluation of Printed Education Materials) modified. From the contribution of these professionals, a new version was developed and evaluated by five children caregivers, using an adaptation of the Doak questionnaire. Results: The first version of the PEM was well-accepted by most of the professionals, as 80.8% of them completely agreed about the quality of the information and 87.5% totally agreed about the legibility and printing features. The second version received 89.1% of approval in the field understanding, 90.6% in self-effectiveness, and 100% in atractiveness, cultural acceptance, and persuasion. Conclusions: The PEM proved to be an important tool to guide the correct preparation and administration of extemporaneous formulations by the caregivers of pediatric patients