Challenges and innovations of drug delivery in older age

Abstract

Both drug delivery performance and various age-related physical, mental and physiological changes can affect drug effectiveness and safety in elderly patients. The many drug delivery systems developed over the years include recent novel transdermal, nasal, pulmonary and orally disintegrating tablets that provide consistent, precise, timely and more targeted drug delivery. Certain drug delivery systems may be associated with suboptimal outcomes in the elderly because of the nature of drug present, a lack of appreciation of the impact of age-related changes in drug absorption, distribution and clearance, the limited availability of pharmacokinetic, safety and clinical data. Polypharmacy, patient morbidity and poor adherence can also contribute to sub-optimal drug delivery systems outcomes in the elderly. The development of drug delivery systems for the elderly is a poorly realised opportunity, with each system having specific advantages and limitations. A key challenge is to provide the innovation that best meets the specific physiological, psychological and multiple drug requirements of individual elderly patients.

Oral delivery of proteins and peptides: Challenges, status quo and future perspectives

“…Generally, in the healthy adult, the pH of gastric fluids is acidic (pH 1.5–3.5), and rises to around pH 5–6 in the duodenum due to neutralization of carbonate and bile juices, and then increases to pH 7–8 in the distal jejunum and ileum, while the colonic pH could be more than 8 or drop to pH 6 with high interindividual variability 33 , 34 . The age growth is almost no effect on GI pH 35 , which indicates the GI pH condition could maintain relative stable in whole life. However, The gastric pH is high shortly after birth, and rapidly reduces to pH 1 to 3 36 .…”

Characteristics of Contents of Lower intestine in the 65–74 Years of Age Range Could Impact the Performance of Safe and Efficacious Modified Release Products

“…Compared with young adults, in older people oesophageal transit times are likely decreased (as a result of dysphagia) and gastric pH values are likely increased (due to reduced gastric acid secretion rates) whereas age-related changes of the intestinal microbiota have also been reported (compared with young adults fecal microbiota is populated by less lactobacilli and more enterobacteria per gram of fresh fecal weight, on average). 2,12,18 In recent years, our knowledge on the environment and the motility of lower intestine (distal ileum and colon) of young adults has been increased substantially, 4,17,22 also from the drug/drug product performance perspective, 10,19 however, relevant information in older people is very limited and focuses primarily to colonic motility in relation to the increased susceptibility of older individuals to constipation and fecal incontinence. 23 Characteristics of the contents in the lower intestine of older people that are important for the performance of oral drug products in the region are missing.…”

Quality-by-Design Approach and Optimization of Risk Factors by Box-Behnken Design in Formulation Development of Aspirin and Glycine Orally Disintegrating Tablet

“…Consequently, ASP and GLY now a day comes up in combination as orally disintegrating tablet (ODT) in different strength (e.g., ASP 75 mg + GLY 37.5 mg, ASP 100 mg + GLY 45 mg etc.). ODTs have gained much interest during the last decade due mainly to their ease of administration in patients with deglutition disorder [7][8][9][10]. Formulation of ODTs, however, has always been a great challenge as many factors can stifle the successful development of ODTs.…”

“…Formulation of ODTs, however, has always been a great challenge as many factors can stifle the successful development of ODTs. Among those factors, taste masking of drug substance, quick disintegration time, low tablet weight, small tablet dimension, enough mechanical strength, physical stability throughout the shelf life are few to mention [8,11].…”