E-drug: TB drug combinations
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Much appreciation on Prof.Laing's comment for four drugs combination
for TB patient. Since, Nepal has stricken hard with the burden of this
disease and DOTS (Direct observation Treatment under Supervision) program
has been successfully implemented. The physico-chemical characteristics of
these drugs are of extreme importance in formulating them together.
Ethambutal is such a hygroscope compound that if moisture does not
remain within the control, it is hydrolyzed into brown compound and
can deteriorate Isoniazid and Pyrazinamide. Where as Rifampicin being
scarlet red influences its color to other compounds with it and prone
to moisture. A great caution has been exercised not to cross -
contaminate during its manufacture in GMP guideline. Therefore, some
of the alternatives will be either formulate all items seperately and
strip them in pouch as combipack or all the four ingredients are
coated and formulated into single dosage form making tablet size
1700mg. This comes out into bolus which is very inconvenient to already TB
sufferers with fragile structure. Yet third alternative would be Rifampicin
and Ethambutol in two seperate dosage forms while Isoniazid and
Pyrazinamide in one dosage form strip pack then in
pouch as suggested above.
Simultaneously administering them under DOT will not affect
dissolution, absorption and bioavailability within the body system.
Every drug has separately got threshold limits and has been tried
successfully. The cost of production will not be affected much in any
way. Cost of packing will be reduced colossally both combipack and
multi ingredient unit dosage form.
Dr.Asfaq Sheak
Chief Drug Admnistrator
Dept.of Drug Administration
Nepal
<dda@ddazz.healthnet.org.np>
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