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Background: Dispensed drugs stored by patients are often in single-dose packages (SDPs) or are crushed and mixed after being removed from a press-through package (PTP) sheet. Information on their stability is extremely limited. To address this, we explored using chemiluminescence (CL) measurements to detect oxidative degradation. Methods: Eight amlodipine, 14 telmisartan, and two warfarin preparations were used as specimens. These preparations were stored at room temperature under various conditions, after which CL was measured. Cellopoly packaging paper was used for SDP. Three light conditions were used (Condition A: darkness, Condition B: indoor diffused light (approximately 400 lx), and Condition C: exposure to 4,000 lx). CL cumulative light output was measured every minute under nitrogen gas conduction and with a sample chamber temperature of 150 °C, for a maximum of 10 min. Luminescence images were obtained simultaneously with the CL measurements. Results: CL was observed on light-exposed tablet surfaces. For each preparation, an increase in the CL value was observed with the duration of light exposure. In the same preparation with the same exposure time, CL tended to be higher in the order of Condition A < B < C. Moreover, CL increased even when no changes in color were observed by the naked eye. A comparison between preparations with the same main ingredients showed differences in the rate of increase in CL with exposure, and each was found to show a different reactivity to light. Conclusions: To the best of our knowledge, this is the first study to visually capture the surface oxidation of tablets exposed to light using the CL method. The CL values, thought to be derived from photooxidation, increased with exposure of tablets and powders to light after SDP. This method can sensitively assess drug degradation due to photooxidation. Further research is needed to establish a CL method for assessing the stability of preparations in clinical settings. [ABSTRACT FROM AUTHOR]

Abstract Background One-dose packaging is frequently used in Japan for elderly patients who are prescribed several medications. It is useful for easy administration and the prevention of misuse or missed medications. Hygroscopic medications are not suitable for one-dose packaging because moisture absorption may alter their properties. Plastic bags with desiccating agents are sometimes used to store hygroscopic medicines in one-dose packaging. However, the relationship between the quantity of desiccating agents and their safety in the storage of hygroscopic medications is poorly understood. Furthermore, older adults might accidentally consume desiccating agents used in food preservation. In this study, we developed a bag that suppresses the moisture absorption of hygroscopic medications without the use of desiccating agents. Methods The bag was manufactured using polyethylene terephthalate, polyethylene, and aluminum film on the outside, and unified with a desiccating film on the inside. Results The relative humidity (RH) in the bag was maintained at approximately 30–40% when the bag was stored at 75% RH and 35 °C. The manufactured bag’s moisture suppressing effect was better than that of plastic bags with desiccating agents when the hygroscopic medications, potassium aspartate and sodium valproate tablets, were stored at 75% RH and 35 °C for 4 weeks. Conclusions The moisture-suppression bag effectively stored and preserved hygroscopic medications and was more effective in inhibiting moisture absorption than plastic bags with desiccating agents under high temperature and humidity conditions. The moisture-suppression bags are expected to be useful for elderly patients who are prescribed several medications in one-dose packaging.

Background: One-dose packaging is frequently used in Japan for elderly patients who are prescribed several medications. It is useful for easy administration and the prevention of misuse or missed medications. Hygroscopic medications are not suitable for one-dose packaging because moisture absorption may alter their properties. Plastic bags with desiccating agents are sometimes used to store hygroscopic medicines in one-dose packaging. However, the relationship between the quantity of desiccating agents and their safety in the storage of hygroscopic medications is poorly understood. Furthermore, older adults might accidentally consume desiccating agents used in food preservation. In this study, we developed a bag that suppresses the moisture absorption of hygroscopic medications without the use of desiccating agents. Methods: The bag was manufactured using polyethylene terephthalate, polyethylene, and aluminum film on the outside, and unified with a desiccating film on the inside. Results: The relative humidity (RH) in the bag was maintained at approximately 30–40% when the bag was stored at 75% RH and 35 °C. The manufactured bag's moisture suppressing effect was better than that of plastic bags with desiccating agents when the hygroscopic medications, potassium aspartate and sodium valproate tablets, were stored at 75% RH and 35 °C for 4 weeks. Conclusions: The moisture-suppression bag effectively stored and preserved hygroscopic medications and was more effective in inhibiting moisture absorption than plastic bags with desiccating agents under high temperature and humidity conditions. The moisture-suppression bags are expected to be useful for elderly patients who are prescribed several medications in one-dose packaging. [ABSTRACT FROM AUTHOR]

The one-dose package is useful for patients who are prescribed multiple medications. However, the one-dose packaging of hygroscopic medications is difficult because the quality of the medication is reduced by moisture absorption. Cellophane polyethylene laminating paper at 20 μm or 30 μm thickness and glassine papers are widely used for one-dose packaging. The basic characteristics, such as water permeability, of these packaging papers have been demonstrated by companies; however, the quality changes of hygroscopic medications stored in these packaging papers are poorly understood. In this study, we compared the relative humidity in packaging papers and the qualities of the stored hygroscopic medications among 20 μm and 30 μm thick cellophane polyethylene laminating paper and glassine paper. Glucobay® 50 mg, Magmitt® 330 mg, and Phosblock® 250 mg tablets were used as hygroscopic medications to be packaged and the relative humidity, weight change, and hardness of tablets were measured. The relative humidity decreased in the order of glassine paper, 20 μm thick cellophane polyethylene laminating paper, and 30 μm thick cellophane polyethylene laminating paper. Additionally, tablets inside the 30 μm thick cellophane polyethylene laminating paper gained the least weight. Therefore, tablets in a 30 μm thick polyethylene laminating paper absorb less moisture than those in other papers. However, the effect was less pronounced at high temperature, even if the relative humidity remained the same. We expect that the results will be used by hospitals and clinical pharmacies to understand the characteristics of packaging papers and ensure appropriate usage.

Introduction: Medication nonadherence in elderly patients could result in a waste of medical expenses in a long-time span as well as deterioration of the patient's medical condition. Aim: The aim of this study is to evaluate the impact of one-dose package dispensing with patient counseling on medication adherence among elderly patients suffering from chronic disorders. Settings and Design: This is prospective, open-labeled, randomized trial carried out at dispensing pharmacy of the secondary care referral hospital, located in resource-limited settings of Anantapur District, Andhra Pradesh, India. Subjects and Methods: A total of 330 (aged ≥60 years) patients were randomly assigned to one of three study groups: Group A (n = 110), no change in dosing and packing; Group B (n = 110), one-dose package dispensing; Group C (n = 110), One-dose package dispensing with patient counseling. Medication adherence levels were measured using a pill count and visual analog scale (VAS) method at baseline and follow-up (after 1 month). Statistical Analysis: Descriptive statistics were used to represent the sociodemographic, clinical, and medication adherence profile of study participants. One-way ANOVA test is used to assess significant differences between three groups with a P < 0.05. Results and Discussion: Medication adherence levels measured by pill count and VAS method were significantly better in Group C (98.98 ± 1.34, 95.09 ± 5.02) one-dose package with patient counseling and Group B (92.93 ± 3.77, 90.09 ± 5.98) one-dose package dispensing than Group A (87.51 ± 6.23, 84.63 ± 6.86) conventional package (P = 0.0001, 0.004). Conclusion: Patients >60 years who are on multiple medications can benefit from one-dose package dispensing and appropriate counseling. This will improve medication adherence hence better outcomes.

The one-dose package is useful for patients who are prescribed multiple medications. However, the one-dose packaging of hygroscopic medications is difficult because the quality of the medication is reduced by moisture absorption. Cellophane polyethylene laminating paper at 20 μm or 30 μm thickness and glassine papers are widely used for one-dose packaging. The basic characteristics, such as water permeability, of these packaging papers have been demonstrated by companies; however, the quality changes of hygroscopic medications stored in these packaging papers are poorly understood. In this study, we compared the relative humidity in packaging papers and the qualities of the stored hygroscopic medications among 20 μm and 30 μm thick cellophane polyethylene laminating paper and glassine paper. Glucobay® 50 mg, Magmitt® 330 mg, and Phosblock® 250 mg tablets were used as hygroscopic medications to be packaged and the relative humidity, weight change, and hardness of tablets were measured. The relative humidity decreased in the order of glassine paper, 20 μm thick cellophane polyethylene laminating paper, and 30 μm thick cellophane polyethylene laminating paper. Additionally, tablets inside the 30 μm thick cellophane polyethylene laminating paper gained the least weight. Therefore, tablets in a 30 μm thick polyethylene laminating paper absorb less moisture than those in other papers. However, the effect was less pronounced at high temperature, even if the relative humidity remained the same. We expect that the results will be used by hospitals and clinical pharmacies to understand the characteristics of packaging papers and ensure appropriate usage., Competing Interests: The authors declare no conflict of interest., (© 2020 The Author(s).)

Improvement in patient waiting time in dispensing pharmacies is an important element for patient and pharmacists. The One-Dose Package (ODP) of medicines was implemented in Japan to support medicine adherence among elderly patients; however, it also contributed to increase in patient waiting times. Given the projected increase in ODP patients in the near future owing to rapid population aging, development of improved strategies is a key imperative. We conducted a cross-sectional survey at a single dispensing pharmacy to clarify the impact of ODP on patient waiting time. Further, we propose an improvement strategy developed with use of a discrete event simulation (DES) model. A total of 673 patients received pharmacy services during the study period. A two-fold difference in mean waiting time was observed between ODP and non-ODP patients (22.6 and 11.2 min, respectively). The DES model was constructed with input parameters estimated from observed data. Introduction of fully automated ODP (A-ODP) system was projected to reduce the waiting time for ODP patient by 0.5 times (from 23.1 to 11.5 min). Furthermore, assuming that 40% of non-ODP patients would transfer to ODP, the waiting time was predicted to increase to 56.8 min; however, introduction of the A-ODP system decreased the waiting time to 20.4 min. Our findings indicate that ODP is one of the elements that increases the waiting time and that it might become longer in the future. Introduction of the A-ODP system may be an effective strategy to improve waiting time.