Pharma additives ‘risk to premature infants’
Difficulties in dosing medicines for premature babies mean some may be exposed to high levels of pharmaceutical excipients which, despite being pharmacologically inactive, could pose a safety risk.
That is the conclusion of researchers at Leicester Royal Infirmary in the UK, who studied the exposure of pre-term infants during routine clinical care at the hospital’s neonatal unit.
In the case of one excipient, the sweetener sorbitol, infants were exposed to levels that are above the maximum recommended exposure limits for adults.
The research team looked at the records of 38 infants over the course of around one year, seven of which had chronic lung disease (CLD), a common complication in premature infants.
The babies were exposed to 20 excipients in a representative sample of the eight most commonly-used drugs, ranging from vitamin and iron supplements to the steroid dexamethasone and diuretics such as furosemide.
In addition to sorbitol, the researchers found the infants were exposed to ethanol and propylene glycol, both associated with neurotoxicity, and the food colorant Ponceau 4R.
The UK Food Standards Agency has recommended the latter be removed from products used in children because of concerns about its effect on neurodevelopment and behaviour. As expected, exposure was increased among the infants with CLD.
The study was not designed to look for any link between excipients and side effects, but the authors, led by Dr Hitesh Pandya, believe the results are a cause for concern.
The researchers concluded that regulators should “lead action to determine whether existing practice constitutes a risk” and how it could be tackled if this is the case.
The study was published in the Fetal & Neonatal Edition of Archives of Disease in Childhood (20 January).
Formulating drugs for use in children poses many difficulties for drugmakers. Given the huge range of body weights between preterm infants and adolescents, for example, it is hard for pharmaceutical companies to justify manufacturing a broad range of doses to serve the relatively small paediatric market.
The result is that around 10% of paediatric patients in primary care – and up to 90% of those in neonatal intensive care – receive medicines ‘off-label’, simply because there is no suitable dosage strength available.
Pharmacists are often forced to compound ingredients into what is known as ‘extemporaneous preparations’, on the order of a physician, for example by dividing and crushing tablets and dispersing them in suspending agents. While necessary, this approach is clearly far removed from Good Manufacturing Practice (GMP).
But the problem is recognised by industry and clinicians alike and, in response to the concerns, drugmakers and paediatric medicine specialists have now formed a European consortium to try to develop an answer.
The European Paediatric Formulation Initiative (EuPFI) is specifically looking at developing a database of excipient safety data relevant to paediatric formulations, as well as improved delivery devices and new ways to make medicines more palatable for children.
It will also look into the possibility of developing ‘stock’ medicines to replace extemporaneous preparations – for example, based on a simple powder mix of excipients and active ingredients that can be reconstituted to the desired strength.
The EuPFI is organising a conference at the Royal Pharmaceutical Society of Great Britain in London, UK, on 2-3 March.
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