This presentation is compiled by “ Drug Regulations” from freely available resources like the FDA on the World wide web.
“Drug Regulations” is a non profit organization which provides free online resource to the Pharmaceutical Professional.
Visit http://www.drugregulations.org for latest information from the world of Pharmaceuticals.
Bioavailability and Bioequivalence StudiesPranav Sopory
BA and BE studies.
Seminar presented in All India Institute of Medical Sciences (AIIMS - New Delhi).
Focus in Pharmacokinetic parameters (Cmax, AUC)
Single dose PK study, Steady state PK study, Modified drug release PK study, In vivo mechanisms, invitro mechanisms, Pharmacodynamic Study, Comparatice Clinical Trials. Biowavers and Biosimilimars.
Reference: CDSCO guideline, USFDA guideline, ICH guidelines
Bioavailability and Bioequivalence StudiesPranav Sopory
BA and BE studies.
Seminar presented in All India Institute of Medical Sciences (AIIMS - New Delhi).
Focus in Pharmacokinetic parameters (Cmax, AUC)
Single dose PK study, Steady state PK study, Modified drug release PK study, In vivo mechanisms, invitro mechanisms, Pharmacodynamic Study, Comparatice Clinical Trials. Biowavers and Biosimilimars.
Reference: CDSCO guideline, USFDA guideline, ICH guidelines
Introduction,Definations,Types of Bioequivalence studies,Invitro,Invivo studies,Biowaivers,Study protocol,Types of study designs,statistical procedures,conclusion
The presentation will give an insight into ICH Q1A Stability testing of New drug products. Here the ppt is much focused on stability requirements for ANDA, no: of batches, storage conditions, testing frequency.
This document contains the mostly asked questions for the job interviews of drug regulatory affairs which will help the candidate ace the interview with ease
Thank me later for this :*)
Bioavailability and bioequivalence – problems and pitfallsinemet
PharmaCon2007 Congress, Dubrovnik, Croatia "New Technologies and Trends in Pharmacy, Pharmaceutical Industry and Education" http://www.pharmacon2007.com
Abstract is available at http://www.pharmaconnectme.com
Introduction,Definations,Types of Bioequivalence studies,Invitro,Invivo studies,Biowaivers,Study protocol,Types of study designs,statistical procedures,conclusion
The presentation will give an insight into ICH Q1A Stability testing of New drug products. Here the ppt is much focused on stability requirements for ANDA, no: of batches, storage conditions, testing frequency.
This document contains the mostly asked questions for the job interviews of drug regulatory affairs which will help the candidate ace the interview with ease
Thank me later for this :*)
Bioavailability and bioequivalence – problems and pitfallsinemet
PharmaCon2007 Congress, Dubrovnik, Croatia "New Technologies and Trends in Pharmacy, Pharmaceutical Industry and Education" http://www.pharmacon2007.com
Abstract is available at http://www.pharmaconnectme.com
Previously certain classes of active substances were required to be manufactured in dedicated or segregated self-contained facilities Certain antibiotics, Certain hormones, Certain cytotoxic ,Certain highly active drugs .This was due to the perceived risk of these active substances.
Pharmaceuticals not covered under these criteria were addressed by a cleaning validation process This involved reduction of the concentration of residual active substance to a level where the maximum carryover from the total equipment train would result in no greater than 1/1000th of the lowest clinical dose of the contaminating substance in the maximum daily dosage of the next product to be manufactured.
This criterion was applied concurrently with a maximum permitted contamination of 10 ppm of the previous active substance in the next product manufactured. Whichever of these criteria resulted in the lowest carryover, constituted the limit applied for cleaning validation. However, these limits did not take account of the available pharmacological and toxicological data They may have been too restrictive or not restrictive enough. EMA therefore felt for a more scientific case by case approach for all classes of pharmaceutical substances.
This presentation highlights the reasons which lead to the withdrawal of the 2002 Guidance of the FDA and the current issue with Blend Uniformity and Content Uniformity Determinations.
WHO has recently issued draft document titled "Guidelines on Validation". These guidelines (i.e., the main text included in this working document) cover the general principles of validation and qualification.
These guidelines focus mainly on the overall concept of validation and are not intended to be prescriptive in specific validation requirements. This document serves as general guidance only and the principles may be considered useful in its application in the manufacture and control of starting materials and finished pharmaceutical products (FPPs), as well as other areas. Validation of specific processes and systems, for example, in sterile product manufacture, requires much more consideration and a detailed approach that is beyond the scope of this document. The general text in this document may be applicable to validation and qualification of premises, equipment, utilities, systems, processes, and procedures.
The draft on the specific topics, the appendices to this main text, will follow. The following is an overview on the appendices that are intended to complement the text of this working document:
Appendix 1: Validation of heating, ventilation and air-conditioning systems - will be replaced by cross reference to WHO Guidelines on GMP for HVAC systems for considerations in qualification of HVAC systems (update - working document QAS/15.639/Rev. 1)
Appendix 2: Validation of water systems for pharmaceutical use - will be replaced by cross-reference to WHO Guidelines on water for pharmaceutical use for consideration in qualification of water purification systems
Appendix 3: Cleaning validation - consensus to retain
Appendix 4: Analytical method validation - update in process
Appendix 5: Validation of computerized systems - update in process
Appendix 6: Qualification of systems and equipment - update in process
Appendix 7: Non-sterile process validation - update already published as Annex 3, WHO Technical Report Series, No. 992, 2015
Comments on this draft document are due by July 12, 2016.
A presentation on this guidance is given below:
Presentation on New WHO Guidance on Validations
Environmental Monitoring describes the microbiological testing under- taken in order to detect changing trends of microbial counts and micro- flora growth within cleanroom or controlled environments. The results obtained provide information about the physical construction of the room, the performance of the Heating, Ventilation, and Air-Conditioning (HVAC) system, personnel cleanliness, gowning practices, the equipment, and cleaning operations.
Over the past decade, environmental monitoring has become more sophisticated in moving from random sampling, using an imaginary grid over the room and testing in each grid, to the current focus on risk assessment and the use of risk assessment tools to determine the most appropriate methods for environmental monitoring.
This presentation gives current trends in the application of risk assessment to the practice of environmental monitoring.
This presentation is compiled from freely available resources like the websites of FDA, EMA ,WHO and research papers published by experts in this field like Sandle, T Reinmüller, B , Hyde, W,, Costello, E.K., Lauber, C. L., Hamady, M., Fierer, N., Gordon, J.I., Knight, R.
Paper published by T. Sandle on clean room contamination was referred extensively for this presentation. “Drug Regulations” is a non profit organization which provides free online resource to the Pharmaceutical Professional.
Visit http://www.drugregulations.org for latest information from the world of Pharmaceuticals.
This presentation gives an overview of : Validation of microbiological methods , Considering some of the limitations and
Key criteria that may be applicable for assessment.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
1. This presentation is compiled by “ Drug Regulations” a
non profit organization which provides free online
resource to the Pharmaceutical Professional.
Visit http://www.drugregulations.org for latest
information from the world of Pharmaceuticals.
12/11/2013
1
2. This presentation is compiled by “ Drug
Regulations” from freely available resources
like the FDA on the World wide web.
“Drug Regulations” is a non profit
organization which provides free online
resource to the Pharmaceutical Professional.
Visit http://www.drugregulations.org for
latest information from the world of
Pharmaceuticals.
Drug Regulations : Online
Resource for Latest Information
12/11/2013
2
3.
Main focus of ANDA application
◦ Bioequivalence of Generic products to RLD
◦ The FD&C Act requirement for BE
The rate and extent of absorption of the drug do not
show a significant difference from the rate and extent
of absorption of the listed drug when administered at
the same molar dose of the therapeutic ingredient
under similar experimental conditions in either a
single dose or multiple doses...
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3
4.
Focus of BE studies for most products
◦ Release of the drug substance from the drug
product into the systemic circulation.
◦ Comparison of the systemic exposure profile of a
Generic drug product to that of the RLD.
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4
5.
Use
“the
most
accurate,
sensitive,
and
reproducible approach available among those
set forth” to demonstrate BE.
◦ ( 21 CFR 320.24(b)).
Use of in vivo and/or in vitro methods
acceptable to establish BE. (21 CFR 320.24)
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12/11/2013
5
6.
Descending order of preference
◦ Pharmacokinetic
◦ Pharmacodynamic
◦ Clinical
◦ In vitro studies.
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6
7.
Statutory definition of BE
◦ Expressed in terms of rate and extent of absorption
of the active ingredient or moiety
◦ Emphasizes the use of pharmacokinetic endpoints
◦ Endpoints determined in biological matrix, such as
blood, plasma, and/or serum,
◦ Indicates release of the drug substance from the
drug product into the systemic circulation.
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7
8.
Statutory definition of BE
◦ Frequently relies on pharmacokinetic endpoints
C max
(peak plasma concentration) and
AUC
(area under the plasma concentration time curve)
Reflective of rate and extent of absorption
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12/11/2013
8
9.
Use measurement of urinary excretion if
serial measurements of the drug or its
metabolites in plasma, serum, or blood
cannot be accomplished.
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12/11/2013
9
10.
Applicant may conduct a pilot study
◦ Conducted before full BE study
◦ Carried out in a small number of subjects
◦ Used to
Validate analytical methodology
Assess variability
Optimize sample collection time intervals
Provide other information.
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12/11/2013
10
11.
FDA recommends an approach given in slides
to follow :
◦ For
both
replicate
and
nonreplicate
in
vivo
pharmacokinetic BE studies,
◦ Elements
can
be
adjusted
for
certain
drug
substances and drug products.
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11
12.
Study conduct:
◦ Administer the test or RLD products with about 8
ounces (240 mL) of water
◦ Use appropriate number of subjects
◦ Use fasting conditions, unless the study is a fed BE
study.
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12
13.
Study conduct:
◦ Fed Treatments:
Subjects should have an overnight fast of at least 10 hours
Start
the
recommended
meal
30
minutes
before
administration of the drug product
Study subjects should eat this meal in 30 minutes or less
Administer the drug product 30 minutes after start of the
meal.
Use 8 fluid ounces (240 mL) of water for administration.
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12/11/2013
13
14.
Study conduct:
◦ Do not allow food for at least 4 hours post dose.
◦ Allow Water as desired except for 1 hour before and
after drug administration.
◦ Give subjects standardized meals
◦ Schedule meals at the same time in each period of
the study.
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Resource for Latest Information
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14
15.
Study conduct:
◦ Administer highest-marketed strength as a single unit.
◦ If
warranted
to
achieve
sufficient
bio-analytical
sensitivity, multiple units of the highest strength can be
administered, provided the total single dose remains
within the labelled dose range and the total dose is safe
for administration to the study subjects.
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15
16.
Study conduct:
◦ Separate each treatment with an adequate washout
period
e.g., more than five half-lives of the moieties to be
measured.
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12/11/2013
16
17.
Study conduct:
◦ State the
lot numbers of both test and RLD products and the
expiration date for the RLD product.
◦ The assayed drug content of the test product batch should not
differ from the RLD product by more than +/- 5 percent.
◦ Include a statement of the composition of the test product
◦ Include a side-by-side comparison of the compositions of test
and RLD products
◦ Retain the test and RLD products for five years. (21 CFR 320.63)
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12/11/2013
17
18.
Study conduct:
◦ Before and during each study phase
Allow subjects to have water as desired, except for 1 hour
before and after drug administration,
Provide subjects with standardized meals no less than 4
hours after drug administration
Ask subjects to abstain from alcohol for 24 hours before
each study period and until after the last sample from each
period has been collected.
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12/11/2013
18
19.
Fed studies test meal
◦ Use meals that provide the greatest effects on gastrointestinal (GI)
physiology and systemic drug availability.
◦ Use a high-fatº & high calorie® test meal
º(approximately 50 per cent of total caloric content of the meal),
®(approximately 800 to 1000 calories)
Test meal should derive approximately 150, 250, and 500-600 calories
from protein, carbohydrate, and fat, respectively.
Provide the caloric breakdown of the test meal in the study report.
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12/11/2013
19
20.
Sample collection and sampling times:
◦ Sample blood, rather than urine or tissue.
◦ Measure the drug or metabolites in serum or plasma.
◦ Analyse whole blood when appropriate
◦ Draw blood samples at appropriate times to describe the
absorption, distribution, and elimination phases of the drug
◦ Collect 12 to 18 samples, including a predose sample, per
subject, per dose.
◦ Continue sampling for at least three or more terminal elimination
half-lives of the drug
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12/11/2013
20
21.
Sample collection and sampling times:
◦ Finalize exact timing for sample collection based on the drug and the rate
of input from the administered dosage form.
◦ Space sample collection to
Maximize concentration of drug in the blood (Cmax) and
Calculate terminal elimination rate constant (Kel)
◦ Obtain at least 3 to 4 samples during the terminal log-linear phase to
obtain an accurate estimate of from linear regression.
z
◦ Record the actual clock time when samples are drawn
◦ Record the elapsed time related to drug administration.
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12/11/2013
21
22.
Subjects with predose plasma drug concentrations:
◦ Include the subject’s data without any adjustments in all
pharmacokinetic measurements and calculations
If the predose concentration is 5 per cent of Cmax value in a
subject with predose plasma concentration
If the predose value is greater than 5 per cent of Cmax, drop the
subject from all BE study evaluations.
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12/11/2013
22
23.
Data deletion because of vomiting:
◦ Delete data from statistical analysis from subjects who experience
emesis during the course of a BE study for immediate release
products if vomiting occurs at or before 2 times median Tmax.
◦ Delete data from the analysis if a subject vomits during a period
of time less than or equal to the dosing interval stated in the
labelling of the product for modified release products.
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12/11/2013
23
24.
Pharmacokinetic information in submissions:
◦ Plasma concentrations and time points
◦ Subject, period, sequence, treatment
◦ Intersubject, intrasubject, and/or total variability, if available
◦ For single-dose BE studies:
AUC0-t, AUC0-inf, and C
max.
In addition, report the following supportive information: Tmax, Kel and t1/2.
◦ For steady-state BE studies: AUC0-tau and CmaxSS. In addition, please report
CminSS (concentration at the end of a dosing interval), CavSS (average
concentration during a dosing interval), degree of fluctuation [(CmaxCmin)/CavSS], swing [(CmaxSS-CminSS)/CminSS], and Tmax.
Drug Regulations : Online
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12/11/2013
24
25.
Statistical information in submissions:
◦ For AUC0-t, AUC0-inf, and Cmax:
Geometric means
Arithmetic means
Geometric mean ratios
90 per cent Confidence intervals (CI)
Do not round off CI values; therefore, to pass a CI limit of 80 to 125 per
cent, the value would be at least 80.00 per cent and not more than 125.00
per cent.
Provide logarithmic transformation for measures used for BE demonstration.
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25
26. ◦ Use
Two-period, two-sequence, two-treatment, singledose, crossover study design, or
A single-dose parallel study design, or
A replicate study design for BE studies.
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26
27.
Perform a two-period, two-sequence, two-treatment,
single-dose, crossover study using healthy subjects
for systemically available drug release.
Give study subject each treatment (test, and RLD) in
random order.
Crossover design may not be practical for drugs with
long pharmacokinetic half-lives
◦ (i.e., longer than 24 hours).
Drug Regulations : Online
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12/11/2013
27
28.
For drugs with long pharmacokinetic half-
lives
◦ Use a single-dose, parallel design
◦ Administer each treatment to a separate group of
subjects with similar demographics.
◦ Use general recommendations for study designs in
designing crossover studies as well.
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Resource for Latest Information
12/11/2013
28
29.
A replicate crossover study may be an
appropriate alternative to the parallel or
nonreplicate crossover study described earler.
This can be conducted as either
◦ Partial (three-way) or
◦ Full (four-way) replication of treatment.
◦ Administer one or both treatments to the same
subject on two separate occasions.
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Resource for Latest Information
12/11/2013
29
30.
The replicate design has the advantage of
using fewer subjects
However each subject should receive more
treatments
than
in
the
two-treatment,
crossover design.
The replicate design is especially useful for
highly variable drugs.
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12/11/2013
30
31.
Use the average BE method of analysis.
Use a scaled-average BE analysis for highly variable
drugs.
Use this approach with a replicate study design.
Submit a complete protocol for review and comment
before commencing the study to the FDA to use
variations of these study designs or analysis methods
(e.g., a sequential design or scaled-average BE),
Drug Regulations : Online
Resource for Latest Information
12/11/2013
31
32.
Use subjects of 18 years of age or older
Subjects should be representative of the general
population considering the age, sex and race.
Include similar proportion of males and females
if the drug will be used in both sexes.
Include as many subjects at or above the age of
60 if the drug is to be used predominantly in the
elderly.
Drug Regulations : Online
Resource for Latest Information
12/11/2013
32
33.
Subjects in a study should be sufficient to provide
adequate statistical power for BE demonstration,
FDA does not expect that there will sufficient power
to draw conclusion for each sub group.
Statistical analysis is not recommended for each sub
group.
Restrictions on admission into a study be based
primarily on safety considerations.
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Resource for Latest Information
12/11/2013
33
34.
Safety considerations preclude the use of healthy
volunteers.
Attempt to enrol patients that the drug is
intended to treat and whose disease process and
treatments are stable for the duration of the BE
study.
An IND for certain BE studies may be required
e.g. certain cytotoxic products.
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35.
FDA
recommends
single-dose
pharmacokinetic studies for both immediate
and modified release drug products.
These studies are generally more sensitive
than steady-state studies.
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36.
Use steady state study to establish BE without
disrupting a patient's on-going treatment
◦ when safety considerations suggest using patients
who are already receiving the medication.
Carry out appropriate dosage administration
and sampling to document the attainment of
steady state.
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37.
Ensure that bioanalytical methods for BE
studies
are
accurate,
precise
selective,
sensitive, and reproducible.
Refer a separate draft guidance for industry
on Bio analytical method validation.
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38.
Rate of absorption ( Peak Exposure)
◦ Assess the rate of absorption by measuring the
peak drug concentration (Cmax) obtained directly
from the data without interpolation
for both single-dose and steady-state studies,.
◦ Obtain information about rate of absorption from
time-to-peak drug plasma concentration(Tmax)
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39.
Partial Exposure
◦ Demonstrate BE by measurements of peak and total
exposure
For orally administered immediate release drug products
◦ Use of partial AUC as an early exposure measure under
certain circumstances.
◦ Relate the time to truncate the partial area to a clinically
relevant pharmacodynamic (PD) measure.
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40.
Extent of Absorption (Total Exposure)
◦ Use following indicators for single-dose studies
Area under the plasma/serum/blood concentration-time curve from
time zero to time t (AUC0-t), where:
t is the last time point with a measurable concentration.
Area under the plasma/serum/blood concentration-time curve from
time zero to time infinity (AUC0-inf), where:
AUC0-inf = AUC0-t + Ct/z
Ct is the last measurable drug concentration
z is the terminal or elimination rate constant calculated according to an
appropriate method.
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41.
Extent of Absorption (Total Exposure)
◦ For steady-state studies
◦ Use the area under the plasma, serum, or blood
concentration-time curve over a dosing interval at
steady-state (AUC0-tau)
where tau is the length of the dosing interval.
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42.
Co-administration
of
food
with
oral
drug
products can influence BE.
Fed BE studies determine whether test and RLD
products
are
bioequivalent
when
co-
administered with meals.
Use a single-dose, two-period, two-treatment,
two-sequence,
crossover
study
for
fed
BE
studies.
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43.
Conduct a fed study when a fasting in vivo BE study is
recommended for an orally administered, immediate
release product
Exception
when
the
dosage
and
administration
section of the RLD labelling states that the product
should be taken only on an empty stomach
◦ (e.g., the labelling states that the product should be
administered 1 hour before or 2 hours after a meal).
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44.
Conduct fasting and fed studies for orally
administered, immediate release products
labelled to be taken only with food.
◦ Exception
when
serious
adverse
events
are
anticipated with fasting administration.
◦ Conduct only a fed study.
◦ Fasting study is not recommended.
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45.
Conduct a fed BE study in addition to a
fasting BE study for all orally administered,
modified-release drug products.
Conduct
these
studies
on
the
highest
strength of the drug product
◦ unless safety considerations preclude the use of
that dose in study subjects.
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46.
Conduct an additional BE study if the label of a
modified release RLD product states that the product
can be administered sprinkled in soft foods.
Sprinkle on one of the soft foods mentioned in the
labelling of the RLD, normally applesauce for each
treatment arm.
Follow the recommendations for fasting BE study
aside from administration in the soft food.
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47.
Administer
specific
beverage
when
labelling
specifies that the product must be administered
in a specific beverage.
Administer these products mixed with one of the
beverages mentioned in the labelling.
Provide evidence that using additional beverages
would not result in BE differences if additional
beverages are listed.
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48.
In Vitro Tests Predictive of Human In Vivo Bioavailability (In
Vitro-In Vivo Correlation Studies)
◦ In vitro-in vivo correlation (IVIVC) is a scientific approach to
describe the relationship between
An in vitro attribute of a dosage form (e.g., the rate or extent of drug
release) and
A relevant in vivo response (e.g., plasma drug concentration or amount
of drug absorbed).
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49.
In Vitro Tests Predictive of Human In Vivo Bioavailability (In Vitro-In Vivo Correlation
Studies)
◦ This model relationship facilitates the rational development and evaluation
of extended-release dosage forms as a surrogate for bioavailability and/or
BE testing and
◦ A tool for formulation screening and setting of the dissolution/drug
release acceptance criteria.
◦ Additional information specifically on the development and validation of
an IVIVC can be found in the guidance for industry on Extended Release
Oral Dosage Forms: Development, Evaluation, and Application of In
Vitro/In Vivo Correlations.
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50.
Pharmacodynamic
◦ Use a suitably validated pharmacodynamic method to demonstrate
BE.
◦ Pharmacodynamic studies not recommended
For drug products that are intended to be absorbed into the systemic
circulation
For which a pharmacokinetic approach can be used to establish BE.
◦ Use well-controlled BE studies with clinical endpoints in patients
when it is not possible to use the previously described methods.
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51.
In Vitro Studies
◦ BE can be evaluated using in vitro approaches (e.g.,
dissolution/drug release testing)
21 CFR 320.24(b).
◦ FDA does not recommend in vitro approaches for drug
products that are intended to be systemically absorbed.
◦ Such
approaches
would
be
appropriate
in
other
circumstances
(e.g., for drug products that bind bile acids in the
gastrointestinal tract).
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52.
For oral solutions, elixirs, syrups, tinctures, or other solubilized
forms, an in vivo BE testing requirement may be waived for
certain products on the ground that in vivo BE is self-evident.
In such instances, the applicant would be deemed to have
complied with and fulfilled any requirement for in vivo BE data.
BE can be waived for
◦ An oral solution if the formulation has the same active ingredient in the
same concentration and dosage form as the RLD, and
◦ Does not contain any excipient that significantly affects drug absorption
or availability.
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53.
Preapproval
◦ Conduct following studies for immediate release
capsule and tablet products.
(1) a single-dose, fasting study comparing the highest
strength of the test and RLD products and
(2) a single-dose, fed BE study comparing the highest
strength of the test and RLD products.
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54.
Preapproval
◦ Appropriate to conduct an in vivo study on a strength other
than the highest with concurrence by the Division of
Bioequivalence, OGD, if the following conditions are met:
Linear elimination kinetics has been documented over the
therapeutic dose range
The higher strengths of the test and RLD products are
proportionally similar to their corresponding lower strength.
Comparative dissolution testing on the higher strength of the
test and RLD products has been submitted and found to be
acceptable.
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55.
Preapproval
◦ An in vivo BE requirement for one or more
strength(s) can be waived based on
(i) acceptable BE study on the designated strength
(ii) acceptable in vitro dissolution testing of all the
strengths
(iii) proportional similarity of the formulations across
all strengths.
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56.
Preapproval
◦ FDA guidance definition of proportionally similar
All active and inactive ingredients are in similar
proportion between different strengths
e.g., a tablet of 50-mg strength has all the inactive
ingredients—almost exactly half that of a tablet of 100mg strength, and almost twice that of a tablet of 25-mg
strength.
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57.
Preapproval
◦ FDA guidance definition of proportionally similar
For high-potency drug substances (where the amount of active
drug substance in the dosage form is relatively low):
(1) the total weight of the dosage form remains nearly the same for
all strengths (within + 10 % of the total weight of the strength on
which a biostudy was performed),
(2) the same inactive ingredients are used for all strengths, and
(3) the change in any strength is obtained by altering the amount of
the active ingredients and one or more of the inactive ingredients.
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58.
Preapproval
◦ FDA guidance definition of proportionally similar
Active and inactive ingredients that are not in similar
proportion
between
different
considered
proportionally
strengths
similar
with
can
be
adequate
justification (such as dosage form proportionality
studies
that
demonstrate
equivalent
in
vivo
bioavailability).
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59.
Preapproval
◦ Under such circumstances
Accompany in vivo BE studies by in vitro dissolution
profiles on all strengths of each product
Conduct the BE study comparing the test product and
the RLD using the strength(s) specified in Approved
Drug
Products
with
Therapeutic
Equivalence
Evaluations.
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60.
Preapproval
◦ For highly soluble, highly permeable, rapidly dissolving,
and
orally
products,
administered
in
demonstrate
vitro
BE
data
based
immediate
may
on
be
the
release
drug
acceptable
to
biopharmaceutics
classification system.
◦ Consult
product
specific
guidance
for
additional
information on BE study design for a specific product.
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61.
Post approval
◦ Refer to the guidance for industry Immediate
Release Solid Oral Dosage Forms, Scale-Up and Post
approval Chemistry, Manufacturing, and Controls;
In
Vitro
Dissolution
Bioequivalence
Testing
Documentation
and
for
In
vivo
information
regarding BE testing recommended for specified
types of post approval changes.
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62.
Post approval
◦ Make
the
in
vitro
comparison
between
the
prechange and postchange products.
◦ When in vivo BE studies are recommended to
support a postapproval change for an ANDA
product, FDA recommends that applicants compare
the postchange ANDA drug product to the RLD and
not to the prechange ANDA product.
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63.
Establish BE for a suspension in the same
manner as for other solid oral dosage forms.
Perform
In
vivo
studies
and
dissolution
testing as described for immediate release
products, or for modified release products.
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64.
A delayed release drug product is a dosage form that
releases a drug at a time later than immediately after
administration
◦ (e.g., the drug product exhibits a lag time in quantifiable plasma
concentrations).
Typically, the coatings (e.g., enteric coatings) have been
designed to delay the release of medication until the
dosage form has passed through the acidic medium of the
stomach.
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65.
In vivo tests for delayed release drug products
are similar to those for extended release drug
products.
FDA recommends that in vitro dissolution tests
for these products document that
◦ They are stable under acidic conditions and
◦ That they release the drug only in a neutral medium
(e.g., pH 6.8).
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66.
An extended release drug product is a dosage form that allows a
reduction in dosing frequency and reduces fluctuations in plasma
concentrations when compared to an immediate release dosage form.
Extended release products can be formulated as capsules, tablets,
granules, pellets, or suspensions.
If any part of a drug product includes an extended release component,
the product should be treated as a modified release dosage form for the
purposes of establishing BE, as specified in following slides.
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67.
Conduct following studies for modified release products,
◦ (1) a single-dose, fasting study comparing the highest strength of the test
with the RLD
◦ (2) a single-dose fed BE study comparing the highest strength of the test
with the RLD product.
Multiple-dose studies are generally not recommended as singledose studies are considered more sensitive in addressing the
primary question of BE.
◦ (e.g., release of the drug substance from the drug product into the
systemic circulation),
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69.
The additional strength is proportionally similar
in its active and inactive ingredients to the test
product strength that underwent acceptable in
vivo studies.
The additional strength has the same drug
release mechanism as the strength of the test
product that underwent an acceptable in vivo
study.
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70.
Dissolution testing of all strengths is acceptable.
FDA recommends that the drug products exhibit similar
dissolution profiles between the strength on which BE
testing was conducted and other strengths based on the f2
test in at least three dissolution media (e.g., pH 1.2, 4.5,
and 6.8).
FDA recommends that applicants generate dissolution
profiles on the test and RLD products of all strengths.
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71.
Refer to FDA’s guidance for industry SUPAC: Modified
Release
Solid
Oral
Dosage
Forms,
Chemistry
Manufacturing and Controls; In Vitro Dissolution
Testing and In vivo Bioequivalence Documentation for
information regarding BE testing recommended for
specified types of postapproval changes for modified
release dosage forms.
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72.
Make an in vitro comparison between the approved (prechange)
product and the test (postchange) product.
Use an f2 test to compare dissolution profiles.
An in vivo BE study may be needed if dissolution profiles are not
shown to be similar.
When in vivo BE studies are recommended to support a
postapproval change for an ANDA product, FDA recommends
that applicants compare the postchange ANDA drug product to
the RLD and not to the prechange ANDA product.
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73.
Administer chewable tablets according to the directions on the
label.
Chew the product if the label states that the tablet must be
chewed before swallowing.
Swallow the product whole, with 240 mL of water, if the label
gives the option of either chewing the product or swallowing it
whole.
FDA recommends to conduct in vitro dissolution testing on
intact, whole tablets of the chewable drug product.
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74.
Always measure the parent drug in the
dosage form in the biological fluids collected
Use alternates if accurate assay quantitation
is
not
possible
using
state-of-the-art-
technology.
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75.
Measure
only
the
parent
drug,
rather
than
metabolites, because the concentration-time profile
of the parent drug is more sensitive to changes in
formulation performance than a metabolite.
Concentration-time profile of metabolite is more
reflective of metabolite formation, distribution, and
elimination.
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76.
Primary metabolite(s), formed directly from the parent
compound, should be measured if they are both:
◦ (1) formed substantially through presystemic metabolism (firstpass, gut wall, or gut lumen metabolism) and
◦ (2) contribute significantly to the safety and efficacy of the
product.
◦ Use this approach for all drug products, including pro-drugs.
◦ Analyse the parent drug using a confidence interval (CI) approach.
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77.
Use the metabolite data to provide supportive
evidence of a comparable therapeutic outcome.
Subject the metabolite data to the CI approach if
the parent drug levels are too low to allow
reliable analytical measurement in blood, plasma,
or serum for an adequate length of time.
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78.
Use an achiral assay to measure the racemate.
Measure individual enantiomers in BE studies when all of the following
conditions have been met:
◦ (1) the enantiomers exhibit different pharmacodynamic characteristics,
◦ (2) the enantiomers exhibit different pharmacokinetic characteristics,
◦ (3) primary efficacy and safety activity reside with the minor enantiomer, and
◦ (4) nonlinear absorption is present (as expressed by a change in the enantiomer
concentration ratio with change in the input rate of the drug) for at least one of the
enantiomers.
Where all of these conditions are met apply BE analysis to the
enantiomers separately.
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79.
Certain drug products contain complex drug substances
(e.g., active moieties or active ingredients that are
mixtures of multiple synthetic and/or natural source
components).
Some or all of the components of these complex drug
substances cannot be fully characterized with regard to
chemical structure and/or biological activity.
FDA does not encourage quantification of all active or
potentially active components in pharmacokinetic studies.
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80.
FDA recommends that applicants base BE studies on a
small number of markers of rate and extent of absorption.
Select markers based on the characteristics of the drug
product.
Criteria for marker selection
◦ Amount of the moiety in the dosage form, plasma, or blood levels
of the moiety, and
◦ Biological activity of the moiety relative to other moieties in the
complex mixture.
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81.
For an oral immediate release product with a long
elimination half-life drug (>24 hrs),
◦ Conduct a single-dose, crossover study,
◦ Use adequate washout period
◦ Use a BE study with a parallel design if the crossover study is
problematic
◦ For either a crossover or parallel study, sample collection time
should be adequate to ensure completion of gastrointestinal
transit of the drug product and absorption of the drug substance.
(which usually occurs within approximately 2 to 3 days).
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82. ◦ Use Cmax and a suitably truncated AUC to characterize
peak and total drug exposure, respectively.
◦ Use an AUC truncated at 72 hours (AUC
0-72 hr)
in place of
AUC0-t or AUC0-inf for drugs that demonstrate low
intrasubject variability in distribution and clearance.
◦ Do not use AUC truncation for drugs demonstrating high
intrasubject variability.
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83.
The first point of a concentration-time curve in a
BE study is sometimes the highest point,
This raises questions of bias in the estimation of
Cmax because of insufficient early sampling times.
Avoid this by a carefully conducted pilot study.
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84.
Assess peak drug concentrations by
◦ Collecting samples between 5 and 15 minutes after dosing
◦ Followed by additional sample collections (e.g., two to five)
in the first hour after dosing
Failure to include early (5-15 minute) sampling times
leading to first time-point Cmax values may result in
FDA not considering the data for affected subjects
from the analysis.
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85.
The consumption of alcoholic beverages can affect
the release of a drug substance
The formulation can
◦ Lose its modified release characteristics
◦ Release drug rapidly
◦ Lead to altered systemic exposure.
This can have deleterious effects on the drug's safety
and/or efficacy.
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86.
Conduct in vitro studies to determine the potential for dose
dumping in alcohol in vivo.
Conduct In vitro assessments of the drug release using media
with various alcohol concentrations.
Conduct an in vivo BE study of the drug product when
administered with alcohol.
Consult Individual Product Bioequivalence Recommendations and
any available relevant product-specific guidance
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87.
Endogenous compounds
◦ Drugs that are already present in the body
◦ The body produces them or they are present in the normal diet.
◦ These compounds are identical to the drug that is being administered,
◦ Difficult to determine the amount of drug released from the dosage form
and absorbed by each subject
◦ Measure and approximate the baseline endogenous levels in blood
(plasma)
◦ Subtract these levels from the total concentrations measured from each
subject after the drug product has been administered.
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88.
Recommended approaches for determining BE
◦ When the body produces the compound,
Measure multiple baseline concentrations in the time period
before administration of the study drug
Subtract the baseline in an appropriate manner consistent
with the pharmacokinetic properties of the drug.
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89.
Recommended approaches for determining BE
◦ When there is dietary intake of the compound,
Strictly control the intake both before and during the study.
House subjects at a clinic before the study
Serve standardized meals containing an amount of the
compound similar to that in the meals to be served on the
pharmacokinetic sampling day
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90.
Recommended approaches for determining BE
◦ For both of the approaches above,
Determine baseline concentrations for each dosing period that are
period specific.
Set value to 0 before calculating the baseline-corrected AUC if a
baseline correction results in a negative plasma concentration value.
Perform pharmacokinetic and statistical analysis on both uncorrected
and corrected data
Determine BE based on the baseline-corrected data
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91.
Determine BE using PK endpoints when a drug substance
produces its effects by local action in the gastrointestinal tract.
Determine
BE
using
clinical
endpoints,
pharmacodynamic
endpoints and/or suitably designed and validated in vitro studies
in
addition
to,
or
instead
of,
measuring
drug
plasma
concentrations in other cases.
Consult
the
guidance
for
industry
Bioequivalence
Recommendations for Specific Products and any available
relevant product-specific guidance
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92.
Submit the method set forth in any related official United
States Pharmacopeia (USP) drug product monograph.
If there is not an official monograph for the proposed
product, use the FDA-recommended and the methods
described in the USP general chapter on dissolution.
A
dissolution
methods
database
describing
FDA-
recommended and USP methods is available to the public
at FDA Data base
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93.
In case a new method is developed include
following information in the submission:
◦ The pH solubility profile of the drug substance.
◦ Dissolution profiles generated at different agitation
speeds
(e.g., 100 to 150 revolutions per minute (rpm)) for USP
Apparatus I (basket), or
50 to 100 rpm for USP Apparatus II (paddle).
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94.
In case a new method is developed include
following information in the submission:
◦ Dissolution profiles generated on all strengths in at least
three dissolution media
e.g., pH 1.2, 4.5, and 6.8 buffer
Water can be used as an additional medium.
If the drug being considered is poorly soluble, use
appropriate concentrations of surfactants.
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95.
Submit dissolution profiles with method set forth
in the USP drug product monograph.
In case a USP drug product monograph is not
available use either
◦ The FDA-recommended method (see the dissolution
methods database)
◦ Develop a method that is specific for your product.
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96.
Submit profiles using the methods described in the
USP general chapter on dissolution or FDA methods
in addition to those three described earlier (e.g., pH
1.2, 4.5 buffer, and 6.8 buffer).
Submit data using the FDA-recommended or USP
method
in
addition
to
proposed
method
for
comparison if a method different from the FDA-
recommended or USP method.
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97.
Select the agitation speed and medium that provide
adequate discriminating ability, taking into account
all the available in vitro and in vivo data.
Use dissolution data from three newly manufactured
batches
of
test
product
to
set
dissolution
specifications for modified release dosage forms.
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98. This presentation was compiled by “ Drug
Regulations” from freely available resources
like the FDA on the World wide web.
“Drug Regulations” is a non profit
organization which provides free online
resource to the Pharmaceutical Professional.
Visit http://www.drugregulations.org for
latest information from the world of
Pharmaceuticals.
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