The unadsorbed nanoparticles of each sample were filtered, and the residue left on the surface of filter paper was dried and kept for characterization and further studies. The optimized sample of AZN was prepared for EDX studies by fixing the samples in a metal stub using an adhesive double-sided tape. The cobalt stub was used to calibrate the machine.
The drug adsorption efficiency of all treated nanohybrids was quantified for adsorbed nanoparti-cles using the method reported by Zubata et al.
The gradient mobile phase composed of acetonitrile, methanol, and buffer with pH 8 at a ratio of was used. The drug adsorption efficiency was calculated. The adsorption equilibrium study was conducted using the Langmuir adsorption isotherm to calculate the adsorption potential of TNPs onto the surface of the drug macromolecule AZ.
Various concentrations of stock suspension containing AZ 0. The prepared nanohybrids were then subjected to equilibrium concentration Ceq of the drug to get maximum adsorption of the TNP on to the surface of drug particles by constructing Langmuir adsorption isotherm model.
The optimized fabricated AZN-7 was selected for conversion to dry suspension. Different formulations were prepared from AZN-7 equivalent to mg of AZ and mixed with various concentrations of excipients to get a stable, taste masked dry suspension. The dry mixture was transferred to amber glass bottles for further studies. The samples were analyzed using the method reported by Zubata et al 32 as discussed above. The reconstituted suspension containing an equivalent amount of AZ mg from each formulation, AZ, and AZN-7 were added to the dissolution medium pH 7.
An equivalent amount of marketed suspension was also analyzed under the same condition for comparative studies. The samples were withdrawn at the specific time of intervals 10, 20, 30, 40, 50, and 60 minutes.
The sink conditions were maintained by replacing with the fresh medium of the same amount. The withdrawn samples were suitably diluted, filtered with Whatman filter paper 42, and quantitatively assayed. The taste masking study was conducted using human volunteers.
All the experimental work on children for taste evaluation was conducted under the approved protocols vide Ref. It is also important to mention that the designed study was conducted in accordance with the Declaration of Helsinki. Prior to conduct the taste masking evaluation studies using human volunteers, the written signed consent proformas were collected from each volunteer. In the current research, volunteers were selected by sequential method Table 1.
Notes: 0, tasteless; 1, very slightly bitter; 2, bitter; 3, very bitter; 4, intense bitter. The sequential test for taste evaluation was performed to analyze and interpret sensory evaluation for the selection of trainee volunteers for panel testing of the final formulation taste evaluation.
In this method, stock suspension containing 3. Each level of taste ranging from tasteless to intense bitter was given numeric values from 0 to 4. In this evaluation method, a total of 25 volunteers divided into five groups were tested for taste threshold and correct evaluation of different tastes. In total, 5 mL of each stock suspension was given randomly to each volunteer in every set of test.
The supertasters and nontasters were rejected through sequential tests. Of 25 trainees, 15 volunteers were approved. The selected 15 volunteers were again divided into five groups and each group consisted of three volunteers. The panel testing method was chosen to evaluate the bitterness of all formulations F1—F In this method, the same procedure as that of sequential method was followed and ranking made on the scale of perception ranging from 0 to 3, with 0 being tasteless and 3 marked as bitter.
Chemical and accelerated stability studies were performed on the optimized formulation of F6 for both dry and reconstituted suspension as per ICH guidelines. The reconstituted samples were kept at refrigeration for 14 days, and the physical and chemical stabilities were analyzed quantitatively for active contents as per schedule.
The theoretical drug loading, experimental drug loading, and percent drug entrapment efficiency were calculated for 10 samples as shown in Table 2. The results in Table 2 exhibited that the AZN-7 was found effective having maximum drug entrapment capacity when the concentration of TiO 2 was This showed that TiO 2 nanoparticles were sufficiently adsorbed onto the surface of AZ particles as reported by Khan et al, 40 which in case of nanoparticles adsorption onto the carrier particles, at a particular concentration of the adsorbate, the surface of adsorbent becomes saturated where there is no chance for the small particles to be further attached onto the surface of adsorbent.
The optimized nanohybrid AZN-7 was selected for further studies including its formulation on the basis of maximum adsorption of nanoparticles on the surface of the drug with the help of entrapment efficiency. The effectiveness of the adsorption using entrapment efficacy was also previously studied by Aboutaleb et al.
It appears in agglomerates as shown in Figure 2B. The adsorption isotherm also confirmed the adsorption. The maximum adsorption of the TNPs was recorded as 2. The Ceqs of the drug and adsorbate TNP were 0. Furthermore, after this concentration 10 mg , no free sites were available on the surface of AZ to adsorb any more TNP. A Scanning electron micrographs of unprocessed azithromycin, B titanium dioxide nanoparticles, and C azithromycin nanohybrid.
A Fourier-transformed infrared spectrum of unprocessed azithromycin, B azithromycin nanohybrid, and C titanium dioxide nanoparticles. The peaks of titanium were observed at 0. The optimized AZN was formulated in the form of dry suspension by using different excipients in various concentrations. The results in Table 3 show that F6 formulation exhibited excellent results when subjected to different studies including physicochemical, content uniformity, and dissolution studies.
Note: Taste code: 0, palatable; 1, very slightly bitter; 2, bitter after taste; 3, bitter. The formulation F6 showed an excellent dissolution rate among all formulation and declared as optimized formulation, as mentioned in Figure 7B , whereas formulations F1 to F5 showed lesser dissolution rate, as shown in Figure 7A , due to the lesser ratio of xanthan gum and HPMC used. The dissolution rate of optimized formulation was compared with its marketed formulation at intestinal pH 7. The dissolution rate of optimized formulation was initially slightly delayed in the first 30 minutes, while at the end of dissolution process 60 minutes , both the AZN optimized formulation and its marketed drug exhibited the same dissolution rate.
However, this compensation of the dissolution rate was due to the faster rate of dissolution of the TNPs at pH 7. At the same time, the sample containing equivalent amount of AZN and AZ raw material was also run, which showed a retarded and delayed dissolution rate when compared with that of optimized formulation and marketed drug taken as standard for comparison.
The excipients have shown a positive effect on dissolution rate in all developed dry suspension dosage forms. The dissolution rate of the optimized formulation of AZN was compared with its marketed counterpart, showing the same dissolution rate compared to its marketed formulation.
Conclusion: The current study concludes that, by fabricating AZ-titanium nanohybrids using physisorption can effectively mask the bitter taste of the drug. The palatability and stability of azithromycin formulation was potentially enhanced without affecting its dissolution rate. Abstract Background: The obnoxious bitter taste of orally taken antibiotics is one of the biggest problems in the treatment of children.
What if I take too much? Common side effects These common side effects of azithromycin happen in more than 1 in people. Keep taking the medicine, but talk to your doctor or pharmacist if these side effects bother you or don't go away: feeling sick nausea diarrhoea or being sick vomiting losing your appetite headaches feeling dizzy or tired changes to your sense of taste Serious side effects Serious side effects are rare and happen in less than 1 in 1, people.
Call a doctor straight away if you get: chest pains or a faster or irregular heartbeat yellow skin or the whites of your eyes turn yellow, or pale poo with dark pee - these can be signs of liver or gallbladder problems ringing in your ears tinnitus , temporary hearing loss, or you feel unsteady on your feet vertigo severe pain in your stomach or back - these can be warning signs of inflammation of the pancreas pancreatitis diarrhoea perhaps with muscle cramps that contains blood or mucus - if you have severe diarrhoea without blood or mucus for more than 4 days you should also speak to a doctor Serious allergic reaction In rare cases it's possible to have a serious allergic reaction anaphylaxis to azithromycin.
Information: You can report any suspected side effect using the Yellow Card safety scheme. Visit Yellow Card for further information. What to do about: feeling sick nausea - stick to simple meals and do not eat rich or spicy food while you're taking this medicine.
Take small, frquent sips if you're being sick. Signs of dehydration include peeing less than usual or having strong-smelling pee. Do not take any other medicines to treat diarrhoea or vomiting without speaking to a pharmacist or doctor.
If it helps, eat smaller meals more often than usual. Snack when you're hungry. Have nutritious snacks that are high in calories and protein, such as dried fruit and nuts. Ask your pharmacist to recommend a painkiller if you need one. Talk to your doctor if the headaches last longer than a week or are severe.
If you begin to feel dizzy, lie down so you don't faint, then sit until you feel better. Do not drive or use tools or machines if you feel dizzy or tired. Do not drink alcohol as it may make you feel worse.
Non-urgent advice: Tell your doctor if you're:. There are some medicines that do not mix well with azithromycin. Tell your doctor if you're taking these medicines before you start azithromycin: antacids for indigestion ergotamine or dihydroergotamine - for migraine warfarin - to thin blood or prevent blood clots ciclosporin or tacrolimus - medicines to stop your immune system overreacting colchicine for gout digoxin for some heart problems rifabutin - an antibiotic nelfinavir - a medicine for HIV a statin medicine to lower your cholesterol - such as simvastatin and atorvastatin You should also let your doctor know if you're taking any medicines for an irregular heartbeat arrhythmia , such as amiodarone or sotalol.
These can include: antidepressants - such as citalopram antipsychotics - used to treat severe mental health problems some antisickness medicines - such as domperidone some antibiotics - such as moxifloxacin Check the leaflets that come with your medicines and talk to a pharmacist or your doctor if you have any worries.
Mixing azithromycin with herbal remedies and supplements There are no known problems with taking herbal remedies or supplements alongside azithromycin. Important: Medicine safety Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
How does azithromycin work? How does azithromycin compare with other antibiotics? When will I feel better? For most infections, you should feel better within a few days. What if I don't get better? Can I drink alcohol with it? Yes, you can drink alcohol with azithromycin. Will it give me thrush? Ask your doctor or pharmacist for advice if this happens to you. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine.
If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. If you miss a dose of this medicine, take it as soon as possible.
However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
Keep from freezing. After water has been added to the powder, use the dose within 12 hours and throw away any unused liquid after your dose. Do not freeze the bottle. Do not keep the oral liquid for more than 10 days. Throw away any unused liquid after all doses are completed. It is very important that your doctor check the progress of you or your child at regular visits to make sure this medicine is working properly.
Blood and urine tests may be needed to check for unwanted effects. If you or your child's symptoms do not improve within a few days, or if they become worse, check with your doctor.
This medicine may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention. Call your doctor right away if you or your child have a rash, itching, hives, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth after you take this medicine.
Serious skin reactions can occur with this medicine. Check with your doctor right away if you or your child have blistering, peeling, or loosening of the skin, red skin lesions, severe acne or skin rash, sores or ulcers on the skin, or fever or chills while you are using this medicine. Check with your doctor right away if you or your child have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin.
These could be symptoms of a serious liver problem. Call your child's doctor right away if your child feels irritable or vomits after feeding. These may be symptoms of a condition called infantile hypertrophic pyloric stenosis.
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