Dosage form therapeutic index

The dosage form should allow accurate and reproducible drag delivery, a particularly important consideration for drugs with a narrow therapeutic index. 

From the point of view of importance and chemical feasibility, chloramphenicol (Figure 9) presented an excellent subject for structural modification. It was the first truly broad-spectrum antibiotic isolated, and its structure and total synthesis were both reported two years after the discovery was announced (40, 41, 42). The synthesis of chloramphenicol analogs proved to be one of the great disappointments of early chemical research in the antibiotic field. Hundreds of analogs were synthesized, but none was found superior to the parent drug in terms either of antimicrobial activity or therapeutic index (43). The palmitate and hemisuccinate esters have provided superior dosage forms for oral and parenteral use. One synthetic analog, thiamphenicol (44) has achieved limited use in human and veterinary medicine. 

Modification of the pharmacokinetics through structural alterations has provided several new steroids with a better GR affinity and therapeutic index and a lower bioavailability than the older drugs (Fig. 33.14). The new inhaled/intranasal glucocorticosteroids like mometasone furoate, budesonide and fluticasone propionate are more lipophilic than those used in oral and systemic therapy and have greater affinity for the GR than does dexamethasone as a consequence of their greater lipophilicity (43). Several of the topical corticosteroids, such as mometasone furoate, BDP, triamcinolone acetonide, and flunisolide, were reintroduced as inhalation and intranasal dosage forms for treatment of respiratory diseases (e.g., asthma or rhinitis). Inhaled budesonide and flunisolide are readily absorbed from the airway mucosa into the blood and are rapidly biotransformed in the liver into inactive metabolites. Mometasone furoate and fluticasone propionate are very potent anti-inflammatory steroids with an oral bioavailability of less than 1%. Obviously, the risk of systemic side effects for these newer corticosteroids is greatly reduced when compared with ... 

FIGURE 27.3 Illustration of how MR dosage forms can more safely deliver narrow therapeutic index APIs. 

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