Scope and Limitations of The Co-Drug Approach to Topical Drug Delivery

Many currently available drugs show unfavourable physicochemical properties for delivery into or across the skin and temporary chemical modulation of the penetrant is one option to achieve improved delivery properties. Pro-drugs are chemical derivatives of an active drug which is covalently bonded to an inactive pro-moiety in order to overcome pharmaceutical and pharmacokinetic barriers. A pro-drug relies upon conversion within the body to release the parent active drug (and pro-moiety) to elicit its pharmacological effect. The main drawback of this approach is that the pro-moiety is essentially an unwanted ballast which, when released, can lead to adverse effects. The term ‘co-drug’ refers to two or more therapeutic compounds active against the same disease bonded via a covalent chemical linkage and it is this approach which is reviewed for the first time in the current article. For topically applied co-drugs, each moiety is liberated in situ, either chemically or enzymatically, once the stratum corneum barrier has been overcome by the co-drug. Advantages include synergistic modulation of the disease process, enhancement of drug delivery and pharmacokinetic properties and the potential to enhance stability by masking of labile functional groups. The amount of published work on co-drugs is limited but the available data suggest the co-drug concept could provide a significant therapeutic improvement in dermatological diseases. However, the applicability of the co-drug approach is subject to strict limitations pertaining mainly to the availability of compatible moieties and physicochemical properties of the overall molecule.

Tolerance of ruminant animals to high dose in-feed administration of a selenium-enriched yeast

The objective of the study was to determine if there were adverse effects on animal health and performance when a range of ruminant animals species were fed at least 10 times the maximum permitted European Union (EU) selenium (Se) dietary inclusion rate (0.568 mg Se/kg DM) in the form of selenium enriched yeast (SY) derived from a specific strain of Saccharomyces cerevisiae CNCM I-3060. In a series of studies, dairy cows, beef cattle, calves and lambs were offered either a control diet which contained no Se supplement or a treatment diet which contained the same basal feed ingredients plus a SY supplement which increased total dietary Se from 0.15 to 6.25, 0.20 to 6.74, 0.15 to 5.86 and 0.14 to 6.63 mg Se/kg DM, respectively. The inclusion of the SY supplement (P < 0.001) increased whole blood Se concentrations, reaching maximum mean values of 716, 1,505, 1,377, and 724 ng Se/mL for dairy cattle, beef cattle, calves and lambs, respectively. Selenomethionine accounted for 10% of total whole blood Se in control animals whereas the proportion in SY animals ranged between 40 and 75%. Glutathione peroxidase (EC 1.11.1.9) activity was higher (P < 0.05) in SY animals when compared with controls. A range of other biochemical and hematological parameters were assessed, but few differences of biological significance were established between treatments groups. There were no differences between treatment groups within each species with regard to animal physical performance or overall animal health. It was concluded that there were no adverse effects on animal health, performance and voluntary feed intake to the administration of at least ten times the EU maximum, or approximately twenty times the US FDA permitted concentration of dietary Se in the form of SY derived from a specific strain of Saccharomyces cerevisiae CNCM I-3060.

The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study

Objectives: To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Design, setting and participants: Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Intervention: Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Main outcome measures: Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Results: Prescribing errors were identified in 3.8% of 2450 medication orders pre-intervention and 2.0% of 2353 orders afterwards (p<0.001; χ2 test). MAEs occurred in 7.0% of 1473 non-intravenous doses pre-intervention and 4.3% of 1139 afterwards (p = 0.005; χ2 test). Patient identity was not checked for 82.6% of 1344 doses pre-intervention and 18.9% of 1291 afterwards (p<0.001; χ2 test). Medical staff required 15 s to prescribe a regular inpatient drug pre-intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre-intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; χ2 test). Conclusions: A closed-loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication-related tasks increased.