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International Journal of Bioprinting Semi-solid extrusion for pediatric medicine

a narrow therapeutic index, 3D printing could provide a of the formulation were easily modified by varying the
viable solution. amounts of the two main excipients, HPMC and gelatin.
Moreover, the production of dispersible film with
3D printing can also improve patient compliance by
reducing the number of tablets to be taken. For example, personalized doses, such as hydrocortisone, can enhance
dose accuracy while improving patient compliance.
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polypills that combine multiple APIs with different release
profiles into a single dosage form offer a practical solution. An important benefit of AM in drug manufacturing
An example is a polypill that incorporates nifedipine is the possibility to tailor treatments to individual patient
and captopril, both used to treat arterial hypertension in requirements and adapt drug release profiles as needed. For
patients with type II diabetes, along with glipizide, which is example, ranitidine hydrochloride was used as a model drug,
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used for the treatment of type II diabetes. Incorporating and it was observed that the addition of corn starch among
all three drugs into a single solid dosage form would be the components resulted in a greater extended release of
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highly beneficial in treating diabetic patients; however, the drug. Similarly, a study prepared immediate-release
the formulation would require the distinct release profile levetiracetam tablets to treat epilepsy, where the dose in
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of each drug. Additionally, polypills that combine, for pediatric patients is subsequently increased over time.
example, an antiemetic with an oral anticancer drug or two This flexibility offered by AM enables tablet preparation
antibiotics in one dose could improve compliance, which that can be easily modified to follow the required dosage
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is a major factor in managing pediatric chronic diseases. regimen. In France, for example, the preparation most
frequently made in hospitals is an immediate-release
One of the significant advantages of 3D printing is its melatonin capsule for various uses, such as alleviating
ability to enhance adherence by developing novel dosage stress before imaging exams or aiding sleep during
forms that are easy to administer and designed with child- hospitalization. However, this formulation often requires
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friendly formulations. These can include different flavors adjustments (i.e., frequently opened) before administration,
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and color profiles, addressing one of the major challenges which can compromise the stability of the drug.
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in pediatrics, i.e., making medicines acceptable to children
who are often reluctant to swallow bitter tablets. For An alternative approach to enhance compliance
example, BACTRIM® (40 mg/mL trimethoprim + 8 mg/ involves preparing solid lipid tablets based on emulsion
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mL sulfamethoxazole, oral suspension) and DALACIN® gels. Unlike previous approaches where blends of lipid
(75 mg/5 mL clindamycin granules for suspension) are excipients are directly printed, these formulations are
marketed in liquid oral form but are often poorly tolerated printed using preformed oil-in-water (O/W) emulsions
due to their unpleasant taste and large volumes required loaded with the poorly soluble drug fenofibrate. The
for administration. 150,151 This can lead to non-compliance, resulting formulations disintegrated in less than 15 min.
increasing the risk of opportunistic diseases or the Besides printing the tablets at room temperature, which
development of antibiotic resistance. is particularly useful for thermolabile compounds, these
formulations are effective for poorly water-soluble drugs,
3D printing can make oral dosage forms more as they help improve their oral bioavailability. The low
appealing for children by producing tablets with eye- temperatures required for material extrusion make
catching appearances and favorable palatability. Some this technique suitable for printing proteins and other
studies have produced chewable dosage forms, while thermosensitive drugs.
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others focused on taste-masking by adjusting excipients
and incorporating pleasant flavors, which can increase Due to the lack of commercially available tacrolimus
adherence to treatment. For example, Karavasili et al. suppositories, these are commonly compounded
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produced pediatric-friendly chocolate-based dosage forms in hospital pharmacy settings using a molding
of paracetamol and ibuprofen, suggesting the possibility of technique, which requires several steps and long
encapsulating the drug paste within a matrix that masks periods of solidification. Suppositories loaded with the
its unpleasant flavor, as in the case of some bitter-tasting immunosuppressant tacrolimus, which are commonly
drugs. used in patients with therapy-resistant inflammatory
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bowel disease (IBD), have already been prepared. Using
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Following these strategies to make medicines more SSE and a suitable combination of lipid excipients, self-
pleasant for children, 3D-printed gummies were fabricated supporting suppositories were directly printed without the
with different shapes (heart, bear, and disc) and colors aid of molds. Moreover, the suppositories were fabricated
using mixtures of gelatin, carrageenan, xanthan gum, in various sizes to accommodate patient comfort and
and sweeteners. Additionally, gelatin and hydroxypropyl dosage requirements. They were prepared using a mixture
methylcellulose (HPMC) hydrogels were used to prepare of Gelucire 44/14 or Gelucire 48/16 and coconut oil, the
gummies with lamotrigine. The viscosity and strength latter served as a plasticizer. Both pharma-inks displayed
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Volume 10 Issue 6 (2024) 57 doi: 10.36922/ijb.4063