Abstract
Developmental physiological changes occur throughout childhood, with important changes observed within the first few weeks and months from birth, potentially affecting drug pharmacokinetics. The impact of confounding factors in relation to the availability of clinically relevant and adequate drug formulations and administration devices is underestimated. Hence, it is important to highlight presently the relevance of formulation issues. Since 2007, the EU Paediatric Regulation enforces paediatric investigation plans in which the applicant has to justify the clinical relevance of each dosage form proposed in relation to age subsets involved and the suitability of administration modalities. Therefore, pediatric drug development has become more relevant, and the importance of using age-appropriate drug formulations has been acknowledged by investigators and other stakeholders. Palatability and acceptability assessment is considered to be important by the regulatory bodies as well as excipient safety and tolerability, as it can be an issue particularly in very young children. However, there remains a lack of research into pediatric biopharmaceutics (methodological input regarding in vitro tools and bridging studies). Clinical pharmacologists with expertise ranging from pharmacodynamics, pharmacokinetics, adverse drug effects, and toxicology should actively contribute in advancing drug formulation issues in children.
Similar content being viewed by others
References
Allegaert K, Anderson BJ, Vrancken M, Debeer A, Desmet K, Cosaert K, Tibboel, Devlieger H (2006) Impact of a paediatric vial on the magnitude of systematic medication errors in neonates. Paediatr Perin Drug Ther 7(2):59–63. doi:10.1185/146300906X105096
Amidon GL, Walgreen CR Jr (2011) Is there a need for a pediatric BCS? In: Meeting minute of Best Pharmaceuticals for Children Act Pediatric Formulations Initiative Workshop November 1–2, 2011 Bolger Center Potomac, MD.Available via http://bpca.nichd.nih.gov/collaborativeefforts/upload/PFI_Workshop_11-1-2-11.pdf. Accessed 06 September 2012: p 6–7
Best BM, Capparelli EV, Diep H, Rossi SS, Farrell MJ, Williams E, Lee G, van den Anker JN, Rakhmanina N (2011) Pharmacokinetics of lopinavir/ritonavir crushed versus whole tablets in children. J Acquir Immune Defic Syndr 58:385–391. doi:10.1097/QAI.0b013e318232b057
Breitkreutz J (2008) European perspectives on pediatric formulations. Clin Ther 30:2146–2154. doi:10.1016/j.clinthera.2008.11.016
Breitkreutz J, Boos J (2007) Paediatric and geriatric drug delivery. Exp Opin Drug Deliv 4:37–45. doi:10.1517/17425247.4.1.37
Chen ML, Straughn AB, Sadrieh N, Meyer M, Faustino PJ, Ciavarella AB, Meibohm B, Yates CR, Hussain AS (2007) A modern view of excipient effects on bioequivalence: case study of sorbitol. Pharm Res 24:73–80. doi:10.1007/s11095-006-9120-4
Clapham D, Kirsanov D, Legin A, Rudnitskaya A, Saunders K (2012) Assessing taste without using humans: rat brief access aversion model and electronic tongue. Int J Pharm 435:137–139. doi:10.1016/j.ijpharm.2012.05.056
Cram A, Breitkreutz J, Desset-Brèthes S, Nunn AJ, Tuleu C (2009) Challenges of developing palatable oral paediatric formulations. Int J Pharm 365:1–3. doi:10.1016/j.ijpharm.2008.09.015
EMA/CHMP/QWP/180157/2011 (2011) Draft guideline on pharmaceutical development of medicines for paediatric use. Available via http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2011/06/WC500107908.pdf, last Accessed 06 september 2012
EMA/CHMP/SWP/888239/201 (2012) Concept paper on the need for revision of the guideline on excipients in the label and package leaflet of medicinal products for human use (CPMP/463/00). Available via http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2012/03/WC500123804.pdf
EMEA CPMP/PWP/EWP/1401/98 Rev.1/Corr** (2010) Guideline on the investigation of bioequivalence Available via http://www.emea.europa.eu/docs/en_GB/document_library/Scientific_guideline/2010/01/WC500070039.pdf Accessed 06 september 2012
EMEA/536810/2008 (2010) Guideline on the investigation of medicinal products in the term and preterm neonate Available via http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2009/09/WC500003750.pdf last Accessed 06 september 2012
EMEA/CHMP/PEG/194810/2005 (2006) Reflection paper: formulations of choice for the paediatric population. Available via http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2009/09/WC500003782.pdf Accessed 06 september 2012
Ernest TB, Craig J, Nunn A, Salunke S, Tuleu C, Breitkreutz J, Alex R, Hempenstall J (2012) Preparation of medicines for children—a hierarchy of classification. Int J Pharm 435:124–130. doi:10.1016/j.ijpharm.2011.06.040
Gaudette NJ, Pickering GJ (2012) The efficacy of bitter blockers on health-relevant bitterants. J Funct Foods 4:177–184. doi:10.1016/j.jff.2011.10.003
Gilbertson TA, Damak S, Margolskee RF (2000) The molecular physiology of taste transduction. Curr Opin Neurobiol 10:519–527. doi:10.1016/S0959-4388(00)00118-5
Kearns GL, Abdel-Rahman SM, Alander SW, Blowey DL, Leeder JS, Kauffman RE (2003) Developmental pharmacology—drug disposition, action, and therapy in infants and children. N Engl J Med 349:1157–1167. doi:10.1056/NEJMra035092
Krause J, Breitkreutz J (2008) Improving drug delivery in pediatric medicine. Pharm Med 22:41–50. doi:10.1007/BF03256681
Kulo A, de Hoon JN, Allegaert K (2012) The propylene glycol research project to illustrate the feasibility and difficulties to study toxicokinetics in neonates. Int J Pharm 435:112–114. doi:10.1016/j.ijpharm.2012.05.014
Notterman DA, Nardi M, Saslow JG (1986) Effect of dose formulation on isoniazid absorption in two young children. Pediatrics 77:850–852
Pandit S, Shah U, Kirby DJ, Nunn T, Tuleu C (2010) Inappropriate oral formulations and information in paediatric trials. Arch Dis Child 95:754–756. doi:10.1136/adc.2009.175661
Richey RH, Craig JV, Shah UU, Ford JL, Barker CE, Peak M, Nunn AJ, Turner MA (2012) The manipulation of drugs to obtain the required dose: systematic review. J Adv Nurs 68:2103–2112. doi:10.1111/j.1365-2648.2011.05916.x
Salunke S, Giacoia G, Tuleu C (2012) The STEP (safety and toxicity of excipients for paediatrics) database. Part 1—a need assessment study. Int J Pharm 435:101–111. doi:10.1016/j.ijpharm.2012.05.004
Shehab N, Lewis CL, Streetman DD, Donn SM (2009) Exposure to the pharmaceutical excipients benzyl alcohol and propylene glycol among critically ill neonates. Pediatr Crit Care Med 10:256–259. doi:10.1097/PCC.0b013e31819a383c
Slack JP, Brockhoff A, Batram C, Menzel S, Sonnabend C, Born S, Mercedes Galindo M, Kohl S, Thalmann S, Ostopovici-Halip L, Simons CT, Ungureano I, Duineveld K, Bologa CG, Behrens M, Furrer S, Oprea TI, Meyerhof W (2010) Modulation of bitter taste perception by a small molecule hTAS2R antagonist. Curr Biol 20:1104–1109. doi:10.1016/j.cub.2010.04.043
Spomer N, Klingmann V, Stoltenberg I, Lerch C, Meissner T, Breitkreutz J (2012) Acceptance of uncoated mini-tablets in young children—results from a prospective exploratory cross-over study. Arch Dis Child 97:283–286. doi:10.1136/archdischild-2011-300958
Thomson SA, Tuleu C, Wong IC, Keady S, Pitt KG, Sutcliffe AG (2009) Minitablets: new modality to deliver medicines to preschool-aged children. Pediatrics 123(2):e235–e238. doi:10.1542/peds.2008-2059
Turner M, Storme T (2012) European Study for Neonatal Excipient Exposure (ESNEE). Eur J Hosp Pharm. doi:10.1136/ejhpharm-2012-000065
Van Riet-Nales DA, Schobben AF, Egberts TC, Rademaker CM (2010) EFFECTS of the pharmaceutical technologic aspects of oral pediatric drugs on patient-related outcomes: a systematic literature review. Clin Ther 32:924–938. doi:10.1016/j.clinthera.2010.05.005
Walsh J, Bickmann D, Breitkreutz J, Chariot-Goulet M (2011) Delivery devices for the administration of paediatric formulations: overview of current practice, challenges and recent developments. Int J Pharm 415: 221-231. DOI:http://dx.doi.org/10.1016/j.ijpharm.2011.05.048
Whittaker A, Currie AE, Turner MA, Field DJ, Mulla H, Pandya HC (2009) Toxic additives in medication for preterm infants. Arch Dis Child Fetal Neonatal Ed 94:F236–F240. doi:10.1136/adc.2008.146035
WHO Development of paediatric medicines: points to consider in pharmaceutical development, Working document QAS/08.257/Rev.3 October 2011. Available via http://www.who.int/medicines/areas/quality_safety/quality_assurance/Rev3-PaediatricMedicinesDevelopment_QAS08-257Rev3_17082011.pdf. Accessed 06 september 2012
Woertz K, Tissen C, Kleinebudde P, Breitkreutz J (2010) Rational development of taste masked oral liquids guided by an electronic tongue. Int J Pharm 400:114–123. doi:10.1016/j.ijpharm.2010.08.042
Woertz K, Tissen C, Kleinebudde P, Breitkreutz J (2011) Taste sensing systems (electronic tongues) for pharmaceutical applications. Int J Pharm 417:256–271. doi:10.1016/j.ijpharm.2010.11.028
Zuccotti GV, Fabiano V (2011) Safety issues with ethanol as an excipient in drugs intended for pediatric use. Expert Opin Drug Saf 10:499–502. doi:10.1517/14740338.2011.565328
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tuleu, C., Breitkreutz, J. Educational Paper: Formulation-related issues in pediatric clinical pharmacology. Eur J Pediatr 172, 717–720 (2013). https://doi.org/10.1007/s00431-012-1872-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-012-1872-8