Purpose: This study describes the development and characterization of glucagon dry powder inhaler (DPI) formulation for pulmonary delivery. Lactose monohydrate, as a carrier, and L-leucine and magnesium stearate (MgSt) were used as dispersibility enhancers for this formulation. Methods: Using Fourier-transform infrared (FTIR) spectroscopy, Differential Scanning Calorimetry (DSC), and Raman confocal microscopy, the interactions between glucagon and all excipients were characterized. The fine particle fractions (FPFs) of glucagon in different formulations were determined by a twin stage impinger (TSI) using a 2.5% glucagon mixture, and the glucagon concentration was measured by a validated LC-MS/MS method. Results: The FPF of the glucagon was 6.4%, which increased six-fold from the formulations with excipients. The highest FPF (36%) was observed for the formulation containing MgSt and large carrier lactose. The FTIR, Raman, and DSC data showed remarkable physical interactions of glucagon with leucine and a minor interaction with lactose; however, there were no interactions with MgSt alone or mixed with lactose. Conclusion: Due to the interaction between L-leucine and glucagon, leucine was not a suitable excipient for glucagon formulation. In contrast, the use of lactose and MgSt could be considered to prepare an efficient DPI formulation for the pulmonary delivery of glucagon.

Background: Dose administration aids (DAAs) or multi-compartment compliance aids are commonly used to organise doses of medications in accordance with a patient’s dosing schedule. Despite their widespread use, there is a paucity of information on the stability of repackaged medications in DAAs. Objectives: The objectives of this work were to evaluate stability studies conducted on repackaged medicine in DAAs and to provide a summary of the latest stability data available. Methods: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed on studies associated with repackaged medications in DAAs and drug stability. PubMed, CINAHL, EMBASE and SCOPUS were searched from January 1998 to June 2021. Key findings: A total of 342 articles were retrieved and 29 articles met the inclusion criteria. Data regarding medications from the reviewed papers were reported according to stability testing and physicochemical properties. The extracted data were then compared with stability information on DAA provision available on the database in the UK. This review identified several discrepancies between this dataset and reported stability and reveals a significant shortage in the stability data of medications repackaged in DAAs. Conclusion: This review highlights the need for further studies to be conducted to better understand the impact of DAA repackaging on the stability, safety and efficacy of medications. It is recommended that a database of stability information of repackaged medications via systematic stability testing studies could be established, serving as a valuable resource for pharmacists when preparing DAAs without compromising patient safety.

Feeding tubes are essential for patients unable to maintain adequate oral intake, serving multiple purposes including nutrition delivery and medication administration. The impact of administering medications through feeding tubes on their stability requires systematic investigation. This review aims to systematically evaluate factors affecting medication stability when administered via enteral feeding tubes versus oral administration in healthy populations, focusing on solid dosage forms converted to liquid formulations. A comprehensive search was conducted across PubMed/MEDLINE, Embase, and CINAHL databases from July to October 2024, using a combination of MeSH and non‐MeSH terms. Studies that assessed medication stability in enteral feeding tubes were included, while those that did not report on this outcome were excluded. The risk of bias was evaluated using ROBINS‐I, RoB‐ II, Cochrane tools, and the QUIN tool. From 2368 articles, 115 were retained for further assessment, and finally 24 met the inclusion criteria and were included, comprising 16 in vivo, 4 in vitro, and 4 combined studies. Approximately 20.8% of the studies found reduced stability/bioavailability for certain medications, such as warfarin and tolvaptan, while 8.3% of the studies found enhanced absorption, as observed with clopidogrel. Most medications maintained their stability. This systematic review suggests that enteral feeding tube administration can variably affect medication stability, influenced by factors such as tube material and preparation methods. Although most medications remain stable, concerns regarding instability and quality persist. The findings of this review provide a foundation for developing evidence‐based guidelines to optimize clinical practice and improve patient outcomes.

Complementary medicines (CMs) are widely used worldwide, with usage rates ranging from 24% to 71.3%. Despite their popularity, many CMs lack robust scientific support and can potentially lead to adverse health effects. Limited research exists on CMs-related adverse events and the role of CMs’ labels in conveying crucial information to consumers. This cross-sectional study investigated the usage, consumer perspectives, and influence of labels specifically on product-based CMs, including nutritional supplements, vitamins, minerals, probiotics, prebiotics, and herbal medicines. Practitioner-led therapies and mind-body practices were outside the scope of this research. Data were collected through an online questionnaire and analyzed using descriptive statistics and correlation analysis. The study enrolled 125 participants who were current CMs users. Pharmacies and supermarkets were the primary sources for CMs procurement. Participants’ perceptions of CMs effectiveness and safety were positively correlated. Label warnings prompted participants to seek additional information, but consultation with healthcare professionals was infrequent. Adverse reactions were reported by 18.5% of participants, with self-management approaches being common. Label warnings play a significant role in prompting consumers to seek more information about CMs. However, the limited engagement of healthcare professionals, especially pharmacists, suggests an opportunity for improved consumer education and pharmacist involvement in CMs-related discussions. Addressing these aspects can lead to safer CMs practices and informed decision-making among consumers.