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NIOSOME
A TARGETTED DRUG DELIVERY SYSTEM
1
Dept. of Pharmaceutics & Pharmaceutical Technology
L. M.College of Pharmacy, Navrangpura,
Ahmedabad-380009
CONTENT
• Introduction
• Structure of Niosome
• Comparison of Niosome v/s Liposome
• Advantages of Niosomes
• Composition of Niosomes
• Method of Preparation of Niosomes
• Characterization of Niosomes
• Applications of Niosomes
• Niosomal preparation
• Study questions
• Reference 2
INTRODUCTION
• Niosomes are a novel drug delivery system, in which the
medication is encapsulated in a vesicle. The vesicle is
composed of a bilayer of non-ionic surface active agents
and hence the name niosomes.
• The niosomes are very small. They are microscopic in size.
Their size lies in the nanometric scale.
• Although structurally similar to liposomes, they offer
several advantages over them.
• Niosomes have recently been shown to greatly increase
transdermal drug delivery and also can be used in targeted
drug delivery, and thus increased study in these structures
can provide new methods for drug delivery.
3
STRUCTURE OF NIOSOME
4
5
 Niosomes are microscopic lamellar structures, which are formed on the
admixture of non-ionic surfactant of the alkyl or dialkyl polyglycerol ether
class and cholesterol with subsequent hydration in aqueous media.
 Structurally, they are similar to liposomes as they are also made up of a
bilayer. However, the bilayer of niosomes is made up of non-ionic surface
active agents rather than phospholipids as seen in the case of liposomes.
 Niosomes may be unilamellar or multilamellar.
 The niosome is made of a surfactant bilayer with its hydrophilic ends
exposed on the outside and inside of the vesicle, while the hydrophobic
chains face each other within the bilayer. Hence, the vesicle holds
hydrophilic drugs within the space enclosed in the vesicle, while
hydrophobic drugs are embedded within the bilayer itself.
 The figure will give a better idea of what a niosome looks like and where the
drug is located within the vesicle. A typical niosome vesicle would consist of
a vesicle forming ampiphile i.e. a non-ionic surfactant such as Span-60,
which is usually stabilized by the addition of cholesterol and a small
amount of anionic surfactant such as diacetyl phosphate, which also helps
in stabilizing the vesicle.
Liposomes: Expensive
Phospholipids are chemically unstable because of their
predisposition to oxidative degradation, they require
special storage and handling and purity of natural
phospholipids is variable. Niosomes do not have any of
these problems.
Niosomes are made of uncharged single-chain
surfactant molecules, while liposomes which are made
from neutral or charged double chained phospholipids.
6
ADVANTAGE
• The vesicle suspension being water based offers greater
patient compliance over oil based systems
• Since the structure of the niosome offers place to
accommodate hydrophilic and lipophilic drugs.
• Improve the therapeutic performance of the drug by
protecting it from the biological environment.
• The vesicles can act as a depot to release the drug slowly
and offer a controlled release.
7
• They increase the stability of the entrapped drug .
• They can be used for oral, parenteral as well topical use.
• They can increase the oral bioavailability of drugs.
• They can enhance the skin penetration of drugs.
• The niosomal dispersions in an aqueous phase can be
emulsified in a non-aqueous phase to control the release
rate of the drug.
8
COMPOSITION
1) Surfactant:
• Niosome vesicles formed by the nonionic surfactant. e.g:
Tween 60, Tween 80
Span 60, Span 80
2) Cholesterol:
• The incorporation of cholesterol into bilayer composition of
niosome induces membrane stabilizing activity and
decreases the leakiness of membrane.
• Hence, incorporation of cholesterol into bilayer increases
entrapment efficiency.
9
3) Organic solvent:
• To dissolve the surfactant & Cholesterol.
• E.g. Dietyl ether, Chloroform
4) Aqeous Media:
• To dissolve the drug.
• E.g. phosphate buffer
10
11
PREPARATION OF NIOSOMES
Sonication
• A typical method of production of the vesicles is by
sonication of solution.
• In this method an aliquot of drug solution in buffer is
added to the surfactant/cholesterol mixture in a 10-ml
glass vial.
• The mixture is probe sonicated at 60°C for 3 minutes using
a sonicator to yield niosomes.
13
Transmembrane pH gradient Drug Uptake Process
• Similar to the hand shaking method.
• Citric acid solution (pH 4.0)
• Resulting multilamellar vesicles are then sonicated.
• To the niosomal suspension, aqueous solution containing
drug is added. The pH of the sample raised to 7.0-7.2 using
1M disodium phosphate (this causes the drug which is
outside the vesicle to become non-ionic and can then cross
the niosomal membrane, and once inside it is again ionized
thus not allowing it to exit the vesicle).
• The mixture is later heated at 60°C for 10 minutes to give
niosome.
14
Ether injection method
• Surfactant is made by dissolving it in diethyl ether. This
solution is then introduced using an injection (14 gauge
needle) into warm water or aqueous media containing the
drug maintained at 60°C.
• Vaporization of the ether leads to the formation of single
layered vesicles.
• The particle size of the niosomes formed depend on the
conditions used, and can range anywhere between 50-
1000µm.
15
Micro fluidization
• Recent technique used to prepare unilamellar vesicles of
defined size distribution.
• Based on submerged jet principle in which two fluidized
streams interact at ultra high velocities, in precisely
defined micro channels within the interaction chamber.
• The impringement of thin liquid sheet along a common
front is arranged such that the energy supplied to the
system remains within the area of niosomes formation.
• The result is a greater uniformity, smaller size and better
reproducibility of niosomes formed.
16
Microfluidization
17
Multiple Membrane Extrusion Method
• Mixture of surfactant, cholesterol and dicetyl phosphate in
chloroform is made into thin film by evaporation.
• The film is hydrated with aqueous drug solution and the
resultant suspension passed through polycarbonate
membranes, which are placed in series for upto 8 passages.
• It is a good method for controlling niosome size.
18
Membrane
19
Reverse Phase Evaporation Technique
• Solution of cholesterol and surfactant in a mixture of
ether and chloroform.
• An aqueous phase containing the drug to be loaded is
added to this, and the resulting two phases are
sonicated at 4-5°C.
• A clear gel is formed which is further sonicated after
the addition of phosphate buffer.
• After this the temperature is raised to 40°C and
pressure is reduced to remove the organic phase.
• This results in a viscous niosome suspension which can
be diluted with PB and heated on a water bath at 60°C
for 10 mins to yield niosomes.
20
The Bubble Method
• Recent technique
• preparation of niosomes without the use of organic solvents.
• The bubbling unit consists of a round bottom flask with three necks,
and this is positioned in a water bath to control the temperature.
• Water-cooled reflux and thermometer is positioned in the first and
second neck, while the third neck is used to supply nitrogen.
Cholesterol and surfactant are dispersed together in a buffer (pH 7.4)
at 70°C.
• This dispersion is mixed for a period of 15 seconds with high shear
homogenizer and immediately afterwards, it is bubbled at 70°C using
the nitrogen gas to yield niosomes.
21
Three neck round bottom flask
22
Formation of Niosomes From Proniosomes
23
 To create proniosomes, a water soluble carrier such as sorbitol is first
coated with the surfactant.
 The coating is done by preparing a solution of the surfactant with
cholesterol in a volatile organic solvent, which is sprayed onto the
powder of sorbitol kept in a rotary evaporator.
 The evaporation of the organic solvent yields a thin coat on the
sorbitol particles.
 The resulting coating is a dry formulation in which a water soluble
particle is coated with a thin film of dry surfactant.This preparation is
termed Proniosome.
 The niosomes can be prepared from the proniosomes by adding the
aqueous phase with the drug to the proniosomes with brief agitation
at a temperature greater than the mean transition phase temperature
of the surfactant.
24
25
Method of preparation Drug incorporated
Ether Injection Sodium stibogluconate
Doxorubicin
Hand Shaking Methotrexte
Doxorubicin
Sonication 9-desglycinamide
8-arginine
Vasopressin
Drugs incorporated into niosomes by various methods
CHARACTERIZATION OF NIOSOMES
26
Entrapment Efficiency
• Drug remained entrapped in niosomes is determined by
complete vesicle disruption using n-propanol and analysing
the resultant solution by appropriate assay method for the
drug.
• Entrapment efficiency (EF) = (Amount entrapped/ total
amount) x 100
27
Vesicle Diameter
• Diameter can be determined using :
Light microscopy,
Photon correlation microscopy
Freeze fracture electron microscopy
28
In-vitro Studies
• Dialysis tubing method.
29
• A dialysis sac is washed and soaked in distilled water. The
vesicle suspension is pipetted into a bag made up of the
tubing and sealed.
• The bag containing the vesicles is placed in 200 ml of
buffer solution in a 250 ml beaker with constant shaking at
37°C.
• At various time intervals, the buffer is analyzed for the
drug content by an appropriate assay method.
30
APPLICATION OF NIOSOME
31
Drug Targetting
• RES preferentially takes up niosome vesicles.
• The opsonins mark the niosome for clearance. Such localization of
drugs is utilized to treat tumors in animals known to metastasize to the
liver and spleen. This localization of drugs can also be used for
treating parasitic infections of the liver.Niosomes can also be utilized
for targeting drugs to organs other than the RES.
• A carrier system (such as antibodies) can be attached to niosomes (as
immunoglobulins bind readily to the lipid surface of the niosome) to
target them to specific organs..
32
Anti-neoplastic treatment
• Most antineoplastic drugs cause severe side effects.
• Niosomes can alter the metabolism, prolong half life of the
drug and decreasing the side effects of the drugs.
• Niosomal entrapment of Methotrexate showed beneficial
effects over the unentrapped drugs, such as decreased rate of
proliferation of the tumor and higher plasma levels
accompanied by slower elimination.
33
Leishmaniasis
• Parasite : Leishmania invades the cells of the liver and
spleen.
• Treatment : derivatives of antimony (antimonials), which in
higher concentrations can cause cardiac, liver and kidney
damage.
• Use of niosomes in tests conducted showed that it was
possible to administer higher levels of the drug without the
triggering of the side effects, and thus allowed greater
efficacy in treatment.
34
Delivery of Peptide drugs
• Challenge : bypassing the enzymes which would
breakdown the peptide.
• Use of niosomes to successfully protect the peptides from
gastrointestinal peptide breakdown is being investigated.
• e.g. Oral delivery of a vasopressin entrapped in niosomes
showed that entrapment of the drug significantly increased
the stability of the peptide.
35
Use in studying Immune Response
• Niosomes are being used to study the nature of the immune
response provoked by antigens.
• Characteristic of niosome :
Immunological selectivity
Low toxicity and
Greater stability
36
Niosomes as Carriers for Hemoglobin
• Carriers for haemoglobin
• The niosomal vesicle is permeable to oxygen and hence can
act as a carrier for haemoglobin in anemic patients.
37
Transdermal Drug Delivery Systems
• Niosome enhance the uptake of drugs through the skin.
• Cosmetics : Topical use of niosome entrapped antibiotics to
treat acne is done.
• Recently, transdermal vaccines utilizing niosomal
technology is also being researched.
• It is prooved that niosomes (along with liposomes and
transfersomes) can be utilized for topical immunization
using tetanus toxoid.
38
OTHER APPLICATIONS
• Niosomes can also be utilized for sustained drug release and
localized drug action.
• It increase the safety and efficacy of many drugs.
• Toxic drugs which need higher doses can possibly be
delivered safely using niosomal encapsulation.
39
Sr. No. Name of Drug Category
1. Finasteride 5-alpha reductase inhibitor
2. Rifampicin Anti-TB
3. Methotrexate Anticancer
4. Gentamicin Aminoglycoside antibiotic
5. Pentoxifylline Brochodilaror
Niosomal Preparation
40
Lancome has come out with a variety of anti-ageing products which are based on niosome
formulations. L’Oreal is also conducting research on anti-ageing cosmetic products. A picture of
the Lancome anti-ageing formulation is below.
STUDY QUESTIONS
• Describe in brief the structure of Niosomes.
Write about method of preparation of Niosomes.
• Write a note on various applications of niosomal drug
delivery system.
• How Niosomal Delivery of medicine is different from
liposomal drug delivery? Write in brief about method
of preparation of niosomes and characterization
thereof.
41
REFERENCE
1. Mujoriya et al, niosomal drug delivery system, Int J app
pharm, vol 3, issue 3, 2011, 7-10.
2. Karim et al, niosome: a future drug delivery system, Jrnl
adva. Pharm. Tech. Res., 2010, vol 1 (4), 374-380.
3. Madhav et al, niosomes: a novel drug delivery system,
ijrpc 2011, 1(3), 498-511.
4. Malhotra M. And Jain N.K. Niosomes as drug carriers.
Indian drugs (1994), 31 (3): 81-86.
42
43
44

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Niosome drug delivery

  • 1. NIOSOME A TARGETTED DRUG DELIVERY SYSTEM 1 Dept. of Pharmaceutics & Pharmaceutical Technology L. M.College of Pharmacy, Navrangpura, Ahmedabad-380009
  • 2. CONTENT • Introduction • Structure of Niosome • Comparison of Niosome v/s Liposome • Advantages of Niosomes • Composition of Niosomes • Method of Preparation of Niosomes • Characterization of Niosomes • Applications of Niosomes • Niosomal preparation • Study questions • Reference 2
  • 3. INTRODUCTION • Niosomes are a novel drug delivery system, in which the medication is encapsulated in a vesicle. The vesicle is composed of a bilayer of non-ionic surface active agents and hence the name niosomes. • The niosomes are very small. They are microscopic in size. Their size lies in the nanometric scale. • Although structurally similar to liposomes, they offer several advantages over them. • Niosomes have recently been shown to greatly increase transdermal drug delivery and also can be used in targeted drug delivery, and thus increased study in these structures can provide new methods for drug delivery. 3
  • 5. 5  Niosomes are microscopic lamellar structures, which are formed on the admixture of non-ionic surfactant of the alkyl or dialkyl polyglycerol ether class and cholesterol with subsequent hydration in aqueous media.  Structurally, they are similar to liposomes as they are also made up of a bilayer. However, the bilayer of niosomes is made up of non-ionic surface active agents rather than phospholipids as seen in the case of liposomes.  Niosomes may be unilamellar or multilamellar.  The niosome is made of a surfactant bilayer with its hydrophilic ends exposed on the outside and inside of the vesicle, while the hydrophobic chains face each other within the bilayer. Hence, the vesicle holds hydrophilic drugs within the space enclosed in the vesicle, while hydrophobic drugs are embedded within the bilayer itself.  The figure will give a better idea of what a niosome looks like and where the drug is located within the vesicle. A typical niosome vesicle would consist of a vesicle forming ampiphile i.e. a non-ionic surfactant such as Span-60, which is usually stabilized by the addition of cholesterol and a small amount of anionic surfactant such as diacetyl phosphate, which also helps in stabilizing the vesicle.
  • 6. Liposomes: Expensive Phospholipids are chemically unstable because of their predisposition to oxidative degradation, they require special storage and handling and purity of natural phospholipids is variable. Niosomes do not have any of these problems. Niosomes are made of uncharged single-chain surfactant molecules, while liposomes which are made from neutral or charged double chained phospholipids. 6
  • 7. ADVANTAGE • The vesicle suspension being water based offers greater patient compliance over oil based systems • Since the structure of the niosome offers place to accommodate hydrophilic and lipophilic drugs. • Improve the therapeutic performance of the drug by protecting it from the biological environment. • The vesicles can act as a depot to release the drug slowly and offer a controlled release. 7
  • 8. • They increase the stability of the entrapped drug . • They can be used for oral, parenteral as well topical use. • They can increase the oral bioavailability of drugs. • They can enhance the skin penetration of drugs. • The niosomal dispersions in an aqueous phase can be emulsified in a non-aqueous phase to control the release rate of the drug. 8
  • 9. COMPOSITION 1) Surfactant: • Niosome vesicles formed by the nonionic surfactant. e.g: Tween 60, Tween 80 Span 60, Span 80 2) Cholesterol: • The incorporation of cholesterol into bilayer composition of niosome induces membrane stabilizing activity and decreases the leakiness of membrane. • Hence, incorporation of cholesterol into bilayer increases entrapment efficiency. 9
  • 10. 3) Organic solvent: • To dissolve the surfactant & Cholesterol. • E.g. Dietyl ether, Chloroform 4) Aqeous Media: • To dissolve the drug. • E.g. phosphate buffer 10
  • 12.
  • 13. Sonication • A typical method of production of the vesicles is by sonication of solution. • In this method an aliquot of drug solution in buffer is added to the surfactant/cholesterol mixture in a 10-ml glass vial. • The mixture is probe sonicated at 60°C for 3 minutes using a sonicator to yield niosomes. 13
  • 14. Transmembrane pH gradient Drug Uptake Process • Similar to the hand shaking method. • Citric acid solution (pH 4.0) • Resulting multilamellar vesicles are then sonicated. • To the niosomal suspension, aqueous solution containing drug is added. The pH of the sample raised to 7.0-7.2 using 1M disodium phosphate (this causes the drug which is outside the vesicle to become non-ionic and can then cross the niosomal membrane, and once inside it is again ionized thus not allowing it to exit the vesicle). • The mixture is later heated at 60°C for 10 minutes to give niosome. 14
  • 15. Ether injection method • Surfactant is made by dissolving it in diethyl ether. This solution is then introduced using an injection (14 gauge needle) into warm water or aqueous media containing the drug maintained at 60°C. • Vaporization of the ether leads to the formation of single layered vesicles. • The particle size of the niosomes formed depend on the conditions used, and can range anywhere between 50- 1000µm. 15
  • 16. Micro fluidization • Recent technique used to prepare unilamellar vesicles of defined size distribution. • Based on submerged jet principle in which two fluidized streams interact at ultra high velocities, in precisely defined micro channels within the interaction chamber. • The impringement of thin liquid sheet along a common front is arranged such that the energy supplied to the system remains within the area of niosomes formation. • The result is a greater uniformity, smaller size and better reproducibility of niosomes formed. 16
  • 18. Multiple Membrane Extrusion Method • Mixture of surfactant, cholesterol and dicetyl phosphate in chloroform is made into thin film by evaporation. • The film is hydrated with aqueous drug solution and the resultant suspension passed through polycarbonate membranes, which are placed in series for upto 8 passages. • It is a good method for controlling niosome size. 18
  • 20. Reverse Phase Evaporation Technique • Solution of cholesterol and surfactant in a mixture of ether and chloroform. • An aqueous phase containing the drug to be loaded is added to this, and the resulting two phases are sonicated at 4-5°C. • A clear gel is formed which is further sonicated after the addition of phosphate buffer. • After this the temperature is raised to 40°C and pressure is reduced to remove the organic phase. • This results in a viscous niosome suspension which can be diluted with PB and heated on a water bath at 60°C for 10 mins to yield niosomes. 20
  • 21. The Bubble Method • Recent technique • preparation of niosomes without the use of organic solvents. • The bubbling unit consists of a round bottom flask with three necks, and this is positioned in a water bath to control the temperature. • Water-cooled reflux and thermometer is positioned in the first and second neck, while the third neck is used to supply nitrogen. Cholesterol and surfactant are dispersed together in a buffer (pH 7.4) at 70°C. • This dispersion is mixed for a period of 15 seconds with high shear homogenizer and immediately afterwards, it is bubbled at 70°C using the nitrogen gas to yield niosomes. 21
  • 22. Three neck round bottom flask 22
  • 23. Formation of Niosomes From Proniosomes 23
  • 24.  To create proniosomes, a water soluble carrier such as sorbitol is first coated with the surfactant.  The coating is done by preparing a solution of the surfactant with cholesterol in a volatile organic solvent, which is sprayed onto the powder of sorbitol kept in a rotary evaporator.  The evaporation of the organic solvent yields a thin coat on the sorbitol particles.  The resulting coating is a dry formulation in which a water soluble particle is coated with a thin film of dry surfactant.This preparation is termed Proniosome.  The niosomes can be prepared from the proniosomes by adding the aqueous phase with the drug to the proniosomes with brief agitation at a temperature greater than the mean transition phase temperature of the surfactant. 24
  • 25. 25 Method of preparation Drug incorporated Ether Injection Sodium stibogluconate Doxorubicin Hand Shaking Methotrexte Doxorubicin Sonication 9-desglycinamide 8-arginine Vasopressin Drugs incorporated into niosomes by various methods
  • 27. Entrapment Efficiency • Drug remained entrapped in niosomes is determined by complete vesicle disruption using n-propanol and analysing the resultant solution by appropriate assay method for the drug. • Entrapment efficiency (EF) = (Amount entrapped/ total amount) x 100 27
  • 28. Vesicle Diameter • Diameter can be determined using : Light microscopy, Photon correlation microscopy Freeze fracture electron microscopy 28
  • 29. In-vitro Studies • Dialysis tubing method. 29
  • 30. • A dialysis sac is washed and soaked in distilled water. The vesicle suspension is pipetted into a bag made up of the tubing and sealed. • The bag containing the vesicles is placed in 200 ml of buffer solution in a 250 ml beaker with constant shaking at 37°C. • At various time intervals, the buffer is analyzed for the drug content by an appropriate assay method. 30
  • 32. Drug Targetting • RES preferentially takes up niosome vesicles. • The opsonins mark the niosome for clearance. Such localization of drugs is utilized to treat tumors in animals known to metastasize to the liver and spleen. This localization of drugs can also be used for treating parasitic infections of the liver.Niosomes can also be utilized for targeting drugs to organs other than the RES. • A carrier system (such as antibodies) can be attached to niosomes (as immunoglobulins bind readily to the lipid surface of the niosome) to target them to specific organs.. 32
  • 33. Anti-neoplastic treatment • Most antineoplastic drugs cause severe side effects. • Niosomes can alter the metabolism, prolong half life of the drug and decreasing the side effects of the drugs. • Niosomal entrapment of Methotrexate showed beneficial effects over the unentrapped drugs, such as decreased rate of proliferation of the tumor and higher plasma levels accompanied by slower elimination. 33
  • 34. Leishmaniasis • Parasite : Leishmania invades the cells of the liver and spleen. • Treatment : derivatives of antimony (antimonials), which in higher concentrations can cause cardiac, liver and kidney damage. • Use of niosomes in tests conducted showed that it was possible to administer higher levels of the drug without the triggering of the side effects, and thus allowed greater efficacy in treatment. 34
  • 35. Delivery of Peptide drugs • Challenge : bypassing the enzymes which would breakdown the peptide. • Use of niosomes to successfully protect the peptides from gastrointestinal peptide breakdown is being investigated. • e.g. Oral delivery of a vasopressin entrapped in niosomes showed that entrapment of the drug significantly increased the stability of the peptide. 35
  • 36. Use in studying Immune Response • Niosomes are being used to study the nature of the immune response provoked by antigens. • Characteristic of niosome : Immunological selectivity Low toxicity and Greater stability 36
  • 37. Niosomes as Carriers for Hemoglobin • Carriers for haemoglobin • The niosomal vesicle is permeable to oxygen and hence can act as a carrier for haemoglobin in anemic patients. 37
  • 38. Transdermal Drug Delivery Systems • Niosome enhance the uptake of drugs through the skin. • Cosmetics : Topical use of niosome entrapped antibiotics to treat acne is done. • Recently, transdermal vaccines utilizing niosomal technology is also being researched. • It is prooved that niosomes (along with liposomes and transfersomes) can be utilized for topical immunization using tetanus toxoid. 38
  • 39. OTHER APPLICATIONS • Niosomes can also be utilized for sustained drug release and localized drug action. • It increase the safety and efficacy of many drugs. • Toxic drugs which need higher doses can possibly be delivered safely using niosomal encapsulation. 39
  • 40. Sr. No. Name of Drug Category 1. Finasteride 5-alpha reductase inhibitor 2. Rifampicin Anti-TB 3. Methotrexate Anticancer 4. Gentamicin Aminoglycoside antibiotic 5. Pentoxifylline Brochodilaror Niosomal Preparation 40 Lancome has come out with a variety of anti-ageing products which are based on niosome formulations. L’Oreal is also conducting research on anti-ageing cosmetic products. A picture of the Lancome anti-ageing formulation is below.
  • 41. STUDY QUESTIONS • Describe in brief the structure of Niosomes. Write about method of preparation of Niosomes. • Write a note on various applications of niosomal drug delivery system. • How Niosomal Delivery of medicine is different from liposomal drug delivery? Write in brief about method of preparation of niosomes and characterization thereof. 41
  • 42. REFERENCE 1. Mujoriya et al, niosomal drug delivery system, Int J app pharm, vol 3, issue 3, 2011, 7-10. 2. Karim et al, niosome: a future drug delivery system, Jrnl adva. Pharm. Tech. Res., 2010, vol 1 (4), 374-380. 3. Madhav et al, niosomes: a novel drug delivery system, ijrpc 2011, 1(3), 498-511. 4. Malhotra M. And Jain N.K. Niosomes as drug carriers. Indian drugs (1994), 31 (3): 81-86. 42
  • 43. 43
  • 44. 44