Novel Dosage Forms and Drug

Delivery Technologies
2
9

PINPIN, RICA

3
0

PONCIANO, TRICIA

3
1

PORNILLOS, ELOISA
2D -PHARMACY
QUEZADA, ESTER

3
2

Composition and Topical

Administration
No. 30
Ponciano, Tricia Ann Panganiban
2D-Pharmacy

 Drug delivery systems that are

modifications of those previously
presented
New in the market
Do not fit into the categories in
previous chapters

Dramatic changes have been

introduced
From traditional capsules
and ointments

 to Osmotic Pumps, Wearable Ambulatory

Pumps, Electrically Assisted Drug Delivery and
other delivery methods based on various Polymer
Technologies

New Drug Delivery System

Development
Based on promoting therapeutic effects of a drug
Minimizing toxic effects by increasing the amount
and persistence of a drug in the vicinity of a target
cell and reducing the drug exposure of nontarget
cells.
Based on Paul Ehrlichs magic bullet concept
(use in the fight against human diseases inspired
generations of scientists to devise powerful
molecular cancer therapeutics.)

It can provide improved or unique

clinical benefits, such as
Improvement of patients
compliance
Improved outcomes
Reduction of adverse effects
Improvement of patients acceptance
of the treatment

It can provide improved or unique

clinical benefits, such as
Avoidance of costly interventions
(laboratory services)
Allowing patients to receive
medication as outpatients
Reduction in the overall use of
medicinal resources

Novel Drug Delivery Systems

PHYSICAL
MECHANISMS
CONTROLLED DRUG DELIVER
SYSTEMS

BIOCHEMICAL
MECHANISMS
Include:
MONOCLONAL ANTIBODIES
GENE THERAPY AND VECTOR
SYSTEMS
POLYMER DRUG ABDUCTS
LIPOSOMES

Include: OSMOSIS
DIFFUSION
EROSION
DISSOLUTION
ELECTROTRANSPORT

Therapeutic Benefits
Optimization of the duration of action of the
drug
Decreasing dosage frequency
Controlling the site of release
Maintaining constant drug levels

Safety benefits
Reducing adverse effects
Decreasing number of concomitant
medications a patient must take
Decreasing the need for interventions
Reducing the number of emergency
department visits

Economic Benefits
Simplifying administration regimens
Enhancing patients
compliance
Overall reduction of
health care costs

COMPOSITION

 Can be quite variable; ranging from

naturally derived substances (gelatin and
sugars),
to the more complex polymers
Also incorporate MECHANICAL, ELECTRONIC and
COMPUTER COMPONENTS

 Therapeutic efficacy- can be enhanced

Toxicity- can be decreased

ex. Degradable bonds can be used to attach an

active drug to a synthetic or naturally occurring
polymer

A number of release profiles

using polymers are possible, as
are actual penetration into
specific target sites.

Potential problems of polymers :

High molecular weight may cause them to be
very slowly excreted from the body
Permeability through various membranes may
be slow (because of size)
Immunologic or toxic reactions may occur
May be labor intensive and expensive to
develop

Novel drug delivery systems

will be discussed in the genera;
categories of topical, oral,
vaginal, implanted, ophthalmic,
and parenteral preparations.

TOPICAL
ADMINISTRATION

TOPICAL ADMINISTRATION
IONTOPHORESIS (IP)

PHONOPHORESIS

IONTOPHORESIS
Electrochemical method that enhances the
transport of some solute molecules by
creating a potential gradient thru skin with an
applied electrical current or voltage.
Induces migration of ionic drugs into the skin
By electrostatic repulsion at the active
electrode: (-)ions- delivered by the cathode
(+)ions- delivered by the anode

IONTOPHORESIS
Consists of
BATTERY
MICROPROCESSOR
CONTROLLER

DRUG RESERVOIR
ELECTRODES

Advantages of IP
Control the delivery rates by variations of
current density, pulsed voltage, drug
concentration, and ionic strength
Eliminating GI incompatibility, erratic
absorption, and first-pass metabolism
Reducing side effects and variation
among patients

Advantages of IP
Avoiding risks of infection, inflammation,
and fibrosis associated with continuous
injection or infusion.
Enhancing compliance with a convenient
and noninvasive therapeutic regimen

Disadvantages of IP

SKIN IRRITATION-at high current

densities; can be
eliminated or
minimized by
reducing the current

Within the next few years,

Miniaturization would be possible
May include electronic record of the date,
time and quantity of each dose delivered,
providing information for determining patient
compliance

USE/S
Since 1930- iontophoresis of PILOCARPINE
Topical delivery of fluoride to the teeth
Dexamethasone as an anti-inflammatory into
joints
Lidocaine as a topical anesthetic
CORTICOSTEROIDS, NONSTEROIDAL ANTIINFLAMMATORY AGENTS, ANESTHETICS
Useful in VETERENARY MEDICINE

NERNST-PLANCK EQUATION:

J=DdC/dX-Z m F C dE/dX
Ji- FLUX
Di- DIFFUSIVITY
dCi/dX- CONCENTRATION GRADIENT
Zi- VALENCE OF SPECIES I,
M- MOTILITY
F FARADAYS CONSTANT
Ci- CONCENTRATION
dE/dX- ELECTROSTATIC POTENTIAL GRADIENT

CURRENT
Can be- direct, alternate, or pulsed
Can have various waveforms- square,
sinusoidal, triangular, and trapezoidal
direct current most commonly used at
this time

FORMULATION FACTORS
Drug concentration, pH, Ionic Strength, Viscosity
drug concentration greater drug delivery
Buffer ions- will compete with the drug for
delivery current, decreasing the quantity of drug
delivered, esp. because theyre smaller and more
mobile than the larger active drug
pH- adjusted & maintained by larger molecules
ionic strength (of the system) - competition
for the available current

FORMULATION FACTORS
Biologic factors- skin to which electrodes are
applied, its THICKNESS, PERMEABILITY, PRESENCE
OF PORES, and so on.
Electroendosmotic flow- voltage difference is
applied across a charged porous membrane
-resulting in bulk fluid flow in
the same direction as the flow of counter ions
-neutral drugs can also be
carried

Iontophoresis- not commercially available,

they must be compounded
Numby Stuff(IOMED)- used to achieve
local anesthesia of the skin and is promoted as
a painless, needleless system.
In VETERINARY PHARMACY- because of the
difference in the size and anatomy of the
animal patient, different electrodes may be
required.

PHONOPHORESIS
-transport of drugs thru the skin using
ultrasound
-combination of ultrasound therapy with the
topical drug therapy to achieve therapeutic
drug concentrations at selected sites in the
skin.

PHONOPHORESIS
-used by PHYSIOTHERAPISTS
-drug is mixed with a coupling agent (gel, cream,
or ointment) that transfers ultrasonic energy
from the phonophoresis device to the skin.
- Head emitting energy at 1 MHz at 0.5 to 1
W/cm2
- May involve: disruption of stratum corneum
lipids, allowing drug to pass thru
the skin.

PHONOPHORESIS
- Ultrasound emitted from the unit is actually
sound waves (outside normal human hearing
range)
- can be reflected, refracted, and absorbed by
the medium

EFFECTS OF ULTRASOUND
1. CAVITATION- formation and collapse of very small
air bubbles in a liquid in contact with ultrasound
waves
2. MICROSTEAMING- results in efficient mixing by
inducing eddies in small-volume elements of a
liquid (may enhance dissolution of suspended drug
particles)
3. HEAT- conversion of ultrasound energy to heat
energy and can occur at the surface of the skin as
well as in deeper layers of the skin.

Vehicle containing the drug- formulated to provide

good conduction of ultrasonic energy to the skin
Product- must be smooth and not gritty
- should have relatively low viscosity for ease
of application and movement of transducer
head
Gels- work very well as a medium
Air- should not be incorporated into product
Hydrocortisone- drug most often administerd (1%10% in a phonophoresis gel).

ORAL ADMINISTRATION
Reported by: Ester Florentina Quezada

Chewable Dispersible Tablets

Lamictal Chewable Dispersible Tablets
Contains 2, 5,or 25mg of lamotrigine and other
inactive ingredients (black currant flavor, calcium
carbonate, low-substituted hydroxypropyl
cellulose, magnesium aluminum silicate,
magnesium stearate, povidone, saccharin sodium,
and sodium starch gycolate)

Chewable Dispersible Tablets

Lamotrigine
Also available as standard swallow tablets
Strengths: 25, 100, 150, and 200mg
Antiepileptic drug

Chewable Dispersible Tablets

Swallow tablets should be swallowed whole
(chewing may leave bitter taste)
Chewable tablets may be swallowed whole,
chewed, or mixed wih water or diluted fruit
juice

Chewable Dispersible Tablets

Didanosine (Videx)
Available as: chewable dispersible buffered tablet,
buffered powder for oral solution, and pediatric
powder for oral solution
Synthetic purine nucleoside analog against HIV
Strengths: 25, 50, 100, 150 and 200mg
Buffered with cacium carbonate and magnesium
hydroxide

Chewable Dispersible Tablets

Didanosine (Videx)
Unstable in acidic soutions
At a pH less than 3 at body temperature, 10% of
didanosine decomposes to hypoxanthine in less
than 2 minutes
Also available as an enteric-coated formulation to
protect it from acidic components of the stomach

Chewable Dispersible Tablets

Tend to be more fragile than standard
compressed tablets
Generally packaged in more sturdy materials
to prevent damage

Mucoadhesive System
Striant mucoadhesive testosterone buccal
system
Designed to adhere to the gum or inner cheek to
provide a controlled and sustained release of
testosterone through the buccal musocsa
Used twice daily (morning and evening)
Contains 30mg of testosterone along with the
inactive ingredients

Osmotic Pump
Alzet (Alza osmotic minipump)
Used in research laboratories to provide constantrate delivery of a drug
Consists of a flexible impermeable diaphragm
surrounded by a sealed layer containing an
osmotic agent that is enclosed within a
semipermeable membrane

Oral Inhalation
Advair Diskus 100/50, 250/50, and 500/50
Contains fluticasone propionate 100, 250, and
500mcg, respectively, along with salmeterol
50mcg in a powder for inhalation
Fluticasone propionate: corticosteroid
Salmeterol xinafoate: highly selective beta-2 adrenergic
bronchodilator

Specialy designed plastic device containing a

double-foil blister strip of a powder formulation

Oral Inhalation
Flovent Rotadisk 50, 100, and 250mcg
Fluticasone propionate alone
Used with Diskhaler Inhalation Device

Oral Inhalation
Foradil Aerolizer
Capsule dosage form for oral inhalation only in the
Aerolizer inhaler
Contains: 12mcg of formoterol fumarate
(bronchodilator) and 25mg of lactose as carrier

Oral Inhalation
Zanamivir for inhaation (Relenza)
Used to treat infuenza
Neuraminidase inhibitor
Packaged in Rotadisks and administered using a
Diskhaler
Usual dose: 2 inhalations twice daily for 5 days

VAGINAL ADMINISTRATION

Intravaginal Drug Delivery System

Advantages of vaginal administration:
Self-insertion and removal
Continuous drug administration at an effective
dose level
Good patient compliance

Intravaginal Drug Delivery System

Polymetric vaginal drug delivery system
The drug may be uniformly distributed throughout
the polymetric matrix
Upon administration and when in contact with
vagina fluids, the drug will slowly dissove and
migrate out of the device .
Long-acting drug delivery system
Ex. Mirena (levonorgestrel-releasing intrauterine
system)
Consists of a T-shaped polyethylene frame with a steroid
reservoir
Prevent pregnancy for up to 5 years

Intrauterine Progesterone Drug

Delivery System
Progestasert System
Slowly releases 60mcg of preogesterone per day
for 1 year after insertion
Local rather than systemic action
The intrauterine device is replaced annually for
the maintenance of contraception

Intrauterine Progesterone Drug

Delivery System
Progestasert System
Advantages:
Using a natural hormone
Containing no estrogens
Using T-shaped delivery device to ensure comfort,
safety, and retention, which minimizes mechanically
induced irritation
Confining the hormonal action to the uterus

Intrauterine Progesterone Drug

Delivery System
Progestasert System
The device contains:
Progesterone suspended in siicone oil
Barium sulfate: to make it radiopaque
Ethylene vinyl acetate membrane: surrounds drug core
and controls rate of drug release
Titanium dioxide: for a white color

Dinoprostone Vaginal Insert

Dinoprostone (Cervidil)
Thick, flat, rectangular polymetric slab enclosed in
a pouch of a knitted polyester retrieval system
Indicated for initiation and/or continuation of
cervical ripening in patients at or near term when
there is medical or obstetrical indication for labor
induction

Estring
Contains a reservoir of estradiol, which is released
immediately and then at a continuous rate of
75mcg per 24 hours over 90 days
For the treatment of urogenital symptoms
associated with postmenopausal atrophy of the
vagina

Crinone Gel
Contains micronized progesterone and the
polymer polycarbophil in an O/W emulsion system
Assists in reproduction

OPHTHALMICS

 Problems associated with the use of

ophthalmic solutions:
Rapid loss of administered drug due to the
blinking of the eye
Flushing effect of lacrimal fluids

GELS
Pilocarpine (Pilopine HS Gel)
Employs carbopol 940, a synthetic high-molecularweight cross-inked polymer of acryic acid

Timolol maleate (Tomoptic-XE)

Employs gellan gum, which forms a gel upon
contact with the precorneal tear films

Ophthalmic Inserts
Lacrisert
A rod-shaped water-solube form of hydroxypropyl
cellulose
Placed in the inferior cul-de-sac of the eye once or
twice daily for the treatment of dry eyes

Ophthalmic Inserts
Pilocarpine Insert
Available in a membrane-controlled reservoir
system that is used in the treatment of glaucoma
Pilocarpine is sandwiched between two ethylene
vinyl acetate membranes
Placed in the cul-de-sac
Release rate: range of 20 or 40mcg per hour for 4
to 7 days

Ophthalmic Inserts
Pilocarpine Insert
Advantages:
Enhanced compliance
No blurred vision or slight discomfort

Release rate of pilocarpine from the EVA system:

Where
dm/dt: release rate
D: diffusion coefficient of the drug
K: partition coefficient
C: difference of the drug concentration
A and h: area and thickness of the system

Ophthalmic Inserts
Pilocarpine Insert
Under routine conditions, the concentration of
the drug in the tears is negligible compared to
that inside the membrane, which is essentially the
solubility of the drug, so the equation can be
written as:

Novel Dosage Forms and Drug

Delivery Technology
Maria Rica F. Pinpin
2D-PH

Parenteral Administration
LONG ACTING PARENTEAL SYSTEMS
Extended rates of drug action following injection may be
achieved by:

slowly dissolving chemical complexes of the drug entity

Solutions/suspensions of drug in slowly absorbed carriers
Large particles of drug in suspension
Injection of slowly eroding microspheres of drug
Rate and duration of drug delivery
- controlled mechanically using controlled - rate drug
infusion pumps

Parenteral Administration
Rate and duration of drug delivery
- controlled mechanically using
controlled - rate drug infusion pumps

Parenteral Administration
Matrix carrier systems examined as a potential means of delivering
peptides and proteins
Ex. Gliadel Wafer - biodegradable polymer loaded with the
chemotherapeutic agent BCNU used for the treatment of recurrent gliomas.
(brain cancer)

Proprietary parenteral products having long lasting

features

Bicillin C-R Injection

Lupron Depot for Suspension

Depo-Provera Contraceptive Injection

Decadron LA Sterile Suspension

Abelcet Amphotericin B Lipid Complex Injection

Parenteral Administration
LIPOSOMES
Composed of small vesicles of a bilayer of phospholipid
encapsulating an aqueous space ranging from:
0.03 to 10 um in diameter
Can encapsulate:
water-soluble drugs
lipid- soluble drugs
Can be administered:
parenterally
topically
inhalation

Parenteral Administration
Preparation:
1. A solution of lipid (lecithin) and organic solvent (acetone/chloroform) are mixed
in a beaker
2. Allow solvent to evaporate (thin film of lipids on the wall of beaker)
3. Add aqueous solution of drug and place in ultrasonic bath
4. Lipids form spheres/cylinders, trapping the aq soln inside
5. It can now be collected, sized, and used

Parenteral Administration
Configurations:
Spherical liposomes
- unilamellar (only one layer) or multilamellar (many
layers)
- designated as:
LUV (large unilamellar vesicles)
- 0.2 um to more than 10 um
SUV (small unilamellar vesicles)
- 0.02 to 0.2 um
MLV (multilamellar vesicles)
- onionskin structure of several layers

Parenteral Administration
Amphipathic phospholipids
Hydrophilic head
- may contain phosphoric acid bound to a water-soluble portion
Hydrophobic tail
- fatty acids containing 10 to 24 C atoms
Similar to hydrophil-lipophil balance and wedge orientation theories

Parenteral Administration
Can be selectively absorbed by tissues rich in
reticuloendothelial cells (liver, spleen, bone
marrow)
Stealth liposomes extend half-life of
liposomes by coating it with e.g. polyethylene
glycol (PEG) enabling it to evade detection
through the components of the body
- may alter biodistribution

Parenteral Administration

Doxorubicin hydrochloride (Doxil) liposome injection

- intravenous administration
- cytotoxic anthracycline antibiotic isolated from Streptomyces peucetius var. caesius
- 90% encapsulated
- surface-bound methoxy polyethylene glycol (protected from detection by
mononuclear phagocyte system)
- increase blood circulation time
- half-life of approximately 55 hours in humans

Parenteral Administration
Advantages:
Liposome-encapsulated drugs are delivered intact
to various tissues and cells and can be released
when liposomes are destroyed (enables sitespecific and targeted drug delivery )
Can be used for both hydrophilic and lipophilic
drugs w/o chemical modification
Decrease drugs toxicity
Size, charge, and other characteristics can be
altered

Parenteral Administration
Disadvantages:
Tendency to be taken up by cells of
reticuloendothelial system
Slow release of drug
Advances in liposome preparations have been
made such as composition, sizing,
classification, and enhancing stability
Potential drug delivery systems

Parenteral Administration

http://images.slideplayer.us/8/2147765/slides/slide_22.jpg

PEGylated Dosage Forms

process of attaching the strands of the polymer PEG to
molecules, most typically peptides, proteins, and
antibody fragments, that can improve the safety and
efficiency of many therapeutics
produces alterations in the physiochemical properties
including changes in conformation, electrostatic
binding, hydrophobicity etc.
increase systemic retention of the therapeutic agent
can influence the binding affinity of the therapeutic
moiety to the cell receptors and can alter the
absorption and distribution patterns.

PEGylated Dosage Forms

Neulasta (pegfilgrastim)
used to treat neutropenia, a lack of certain white blood cells caused by cancer chemotherapy
Covalent conjugate of recombinant methionyl human granulocyte colony-stimulating factor (G-CSF)
and monomethoxypolyethyleneglycol
Filgrastim is a water-soluble 175 amino acid protein with a molecular weight of approximately 19
kilo Daltons (kD).
Filgrastim is obtained from the bacterial fermentation of a strain of E coli transformed with a
genetically engineered plasmid containing the human G-CSF gene.
Pegfilgrastim - 20 kD monomethoxypolyethylene glycol molecule is covalently bound to the Nterminal methionyl residue of filgrastim.
average molecular weight of pegfilgrastim - approximately 39 kD.
Neulasta is supplied in 0.6 mL prefilled syringes for subcutaneous injection.
Each syringe contains 6 mg pegfilgrastim (based on protein weight)
sterile, clear, colorless, preservative-free solution (pH 4.0) containing acetate (0.35 mg), polysorbate
20 (0.02 mg), sodium (0.02 mg), and sorbitol (30 mg) in Water for Injection, USP.

PEGylated Dosage Forms

Pegasys (peginterferon alfa-2a)

Tx of hepatitis C virus
sterile, preservative-free, colorless to light yellow injectable
solution administered subcutaneously
Produces maximal serum concentration at 72 to 96 hours
after dosing that are sustained for up to 168 hours

PEGylated Dosage Forms

Comparison with Roferon-A
PEGASYS

ROFERON-A

Mean systemic
clearance

94mL per hour

1/100

100/100

Mean terminal
half-life after subQ

80 hrs
(range 50 to 140
hrs)

5.1 hrs
(range 3.7 to 8.5
hrs)

PEGylated Dosage Forms

PEG-Intron (peginterferon alfa-2b Powder for Injection)

Covalent conjugate of recombinant alfa interferon with PEG
PEG portion approximate molecular weight of 12kD
PEG-Intron - approximate molecular weight of 31kD
White to off-white lyophilized powder supplied in 2 mL vials for
subcutaneous use
treat adults who have chronic hepatitis C infection with stable liver
problems and who cannot take ribavirin

PEGylated Dosage Forms

Comparison with interferon alfa-2b:
- 1/7 mean apparent clearance
- fivefold greater mean half-life (permits
reduced dosing frequency)
- 10-fold greater maximum concentration
- 50-fold greater area under curve

Fusion Protein: Special Handling

ONTAK

Denileukin diftitox (Ontak)

Fusion protein designed to direct the cytocidal action of diphtheria
toxin to cells which express the interleukin-2 (IL-2) receptor
Molecular weight of 58 kD
Single-use vials (2ml)
Tx of pt with recurrent cutaneous T cell lymphoma whose malignant
cells express the CD25 component of IL-2 receptor

Fusion Protein: Special Handling

Must only be used by physicians experienced
in the use of antineoplastic therapy and
management of pt with cancer
Use must be in pt managed in a facility
equipped and staffed for cardiopulmonary
resuscitation
Pt can be closely monitored for appropriate
period based on their health status

Fusion Protein: Special Handling

Special handling:
Must be in room temp before preparing the dose
Thawed in ref for not more than 24 hrs or at
room temp for 1 2 hrs
May be mixed by gentle swirling
* do not vigorously shake
After thawing, a haze may be visible
* haze should clear in room temp

Fusion Protein: Special Handling

Must be clear, colorless, and without visible particulate matter
Must not be refrozen
Administration:
a. Prepared and held in syringes or plastic intravenous bags (adsorption to
glass may occur in dilute state)
b. Conc must be at least 15 ug/mL during all steps in the preparation of the
solution for IV infusion
c. Should not be physically mixed with other drugs
d. Do not administer through an in-line filter
e. Prepared solution must be administered within six hours using a syringe
pump or IV Infusion bag.
f. Unused portions should be discarded immediately.
Pharmacist, nurses and physicians should carefully read and understand all
of the precautions explained in the package labeling.

Implants
Pornillos, Ma. Eloisa Joanne E.

Implants- sterile solid drug products made by

compression, melting or sintering
Generally consist of the drug ans rate-controlling
excipients.

Gliadel Wafer Implant

Polifeprosan 20 with carmustine implant
A sterile off white to pale yellow wafer
1.45 cm in diameter
1 mm thick

To deliver the carmustine directly into the

surgical cavity created when
a brain tumor is resected

 Carmustine is released from the wafer

diffuses into the surrounding brain tissue,
producing antineoplastic effect
by alkylating DNA and RNA
In 3 weeks, more than 70%of copolymer
degrades
Carboxyphenoxypropane eliminated by kidney
Sebacic acid metabolized by the liver
Expired as CO2

 Each wafer contains 7.7 mg of carmustine

When 8 wafers are use a dose of 61.6 mg is delivered

Each wafer is double-pouched in foil

Inner pouch is sterile
Stored at or below -22 C

Gliadel wafer implanted in the brain

Zoladex Implant
Goserelin acetate (Zoladex) implant
- a sterile , biodegradable product containing
goserelin acetate
- designed for subcutaneous injection with
continuous release over 28 days
- Disperse in a matrix consisting of D, L- Lactating
and glycolic acids copolymer
- Sterile white to cream colored cylinder

 The unit is packaged in a seal light- and

moisture-proof aluminum foil laminate pouch
containing a desiccant capsule
Indicated for a number of disease :
Treatment of endometriosis
Advanced breast cancer

Administered subcutaneously into the upper

abdominal wall using aseptic technique

 Also available as Zoladex 3-Month

Vantas Implant
Vantas (histrelin) implant is a sterile nonbiodegradable, diffusion-controlled reservoir
drug delivery system
Continuously for 12 months
Contains 50 mg of histrelin acetate
A synthetic nonapeptide analog of the naturally
occuring GnRH or LH-RH

Device must be removed after 12 months

 The sterile implant contains 50 mg histrelin

acetate drug core inside a nonbiodegradable,
3.5 cm by 3 mm cylindrically shaped hydrogel
reservoir, which also contains stearic acid.

Viadur Implant
The Viadur (leuprolide acetate) implant
Sterile, no biodegradable, osmotically driven
miniaturized implant designed to deliver
leuprolide acetate
12 months
After 12 months, the implant must be removed

 Viadur is indicated in the treatment of advanced prostate

cancer
Weighs about 1.1 g

Vitrasert Implants
Contains 4.5 mg of the antiviral drug
ganciclovir
Used to treat AIDS-related CMV retinitis
Does not cure the CMV retinits
Helps to decrease its progession

Surgically implanted into the vitreous cavity of

the eye

 Follow up opthalmological examinations are

required and the Vitrasert removed and
replaced with a new implant once the
contents of the original implant have been
depleted.

 Only treats the eye in which it has been

implanted and does not demonstrate any
systemic effect
Adverse effect
Loss of visual acuity
Vitreal hemorrhage
Retinal detachment

Preganancy Category C
Associated with carcinogenicity and
mutagenicity
Disposed properly

Other Novel Delivery System

Definity
Vial of perflutren lipid microspheres for preparing
an injectable suspension
Contains components that upon activation yield
perflutren lipid microspheres
Used as a diagnostic agent during echocariographic
procedures

Administered intravenously

Other Novel Delivery System

It may be activated prior to use with a mechanical
shaking device
Milky white suspension
1.2 x 1010 perflutren lipid microspheres
150 ul/ml of octafluoropropane

Other Novel Delivery System

Minocycline Hydrochloride (Arestin)
Microspheres is a subgingival sustained-release
product contaning minocycline hydrochloride

Doxycycline hyclate (atridox) 10% in the Atrigel

delivery system
Controlled release in subgingival applications.
Composed of 2 syringe mixing system
Syringe A -450 mg of Atrigel delivery system
Syringe B doxycycline hyclate

Other Novel Delivery System

Once prepared, the product is yellow viscous
liquid with a concentration of 10% doxycycline
hyclate in the gel

Cyanobalamin (Nascobal Gel)

Intranasal administration is used in the treatment
of vitamin B12 deficiency, including pernicious
anemia
Self-administered as a nasal gel
Once weekly
Cyanobalamin is absorbed through the nasal
mucosa to produce therapeutic blodd levels

Autoinjection Systems
EpiPen and EpiPen Jr.
Automatic injectors
Contain 2 ml of epinephrine injection for
emergency intramuscular use
Latex free injection

Autoinjection Systems
Each 0.3 ml of the solution contains 0.3 mg
epinephrine
1.8 mg sodium chloride
0.3 mg epinephrine
0.5 mg sodium metabisulfite
Hydrochloric acid

Autoinjection Systems
Designed as emergency supportive therapy of
allergic reactions
Not a replacement for immediate medical or
health care

Epinephrine
Sympathomimetic amine
Deteriorate air and light
Turns pink from oxidation brown, formulation
of melanin

Autoinjection Systems
Humulin N Pen contains NPH human insulin
isophane suspension in a disposable insulin
delivery system

Safe Needle Systems

Needlestick safety and Prevention Act
Enoxaparin sodium injection (Lovenox)
Prefilled syringe with an automatic safety device