Oral Fixed-Dose Combination Pharmaceutical Products: Industrial Manufacturing Versus Personalized 3D Printing

Fixed-dose combination (FDC) products containing at least two different active pharmaceutical ingredients are designed to treat more effectively different pathologies as they have demonstrated to enhance patient compliance. However, the combination of multiple drugs within the same dosage form can bring many physicochemical and pharmacodynamic interactions. The manufacturing process of FDC products can be challenging, especially when it is required to achieve different drug release profiles within the same dosage form to overcome physicochemical drug interactions. Monolithic, multiple-layer, and multiparticulate systems are the most common type of FDCs. Currently, the main manufacturing techniques utilized in industrial pharmaceutical companies rely on the use of combined wet and dry granulation, hot-melt extrusion coupled with spray coating, and compression of bilayered tablets. Nowadays, personalized medicines are gaining importance in clinical settings and 3D printing is taking a highlighted role in the manufacturing of complex and personalized 3D solid dosage forms that could not be manufactured using conventional techniques. In this review, it will be discussed in detail current marketed FDC products and their application in several diseases with an especial focus on antimicrobial drugs. Current industrial conventional techniques will be compared with 3D printing manufacturing of FDCs. Graphical Abstract

[1]  Ranjit Thakuria,et al.  Drug‑Drug and Drug‑Nutraceutical Cocrystal/Salt as Alternative Medicine for Combination Therapy: A Crystal Engineering Approach , 2018 .

[2]  T. Fahey,et al.  Fixed-dose combination antihypertensives and risk of medication errors , 2018, Heart.

[3]  Viktor Lazorkin,et al.  New Four-Die Forging Devices (FDFD) Design Solutions and Open-Die Forging Technologies , 2018 .

[4]  Donald Wlodkowic,et al.  3D-Printed Chips: Compatibility of Additive Manufacturing Photopolymeric Substrata with Biological Applications , 2018, Micromachines.

[5]  Abdul W. Basit,et al.  Non-destructive dose verification of two drugs within 3D printed polyprintlets. , 2020, International journal of pharmaceutics.

[6]  Jean Paul Remon,et al.  Hot‐melt co‐extrusion: requirements, challenges and opportunities for pharmaceutical applications , 2014, The Journal of pharmacy and pharmacology.

[7]  E. Seoane-Vazquez,et al.  Fixed-Dose Combination Drug Approvals, Patents and Market Exclusivities Compared to Single Active Ingredient Pharmaceuticals , 2015, PloS one.

[8]  D. Serrano,et al.  Market Demands in 3D Printing Pharmaceuticals Products , 2019, 3D Printing Technology in Nanomedicine.

[9]  Simon Gaisford,et al.  3D Printing of Medicines: Engineering Novel Oral Devices with Unique Design and Drug Release Characteristics. , 2015, Molecular pharmaceutics.

[10]  Stefan Zeuzem,et al.  Ledipasvir and sofosbuvir for untreated HCV genotype 1 infection. , 2014, The New England journal of medicine.

[11]  Orestis L. Katsamenis,et al.  A 3D printed bilayer oral solid dosage form combining metformin for prolonged and glimepiride for immediate drug delivery , 2018, European journal of pharmaceutical sciences : official journal of the European Federation for Pharmaceutical Sciences.

[12]  R. Alarcón,et al.  Application and Possibilities of Supercritical CO2 Extraction in Food Processing Industry: An Overview , 2002 .

[13]  Omar Sprockel,et al.  Review of bilayer tablet technology. , 2014, International journal of pharmaceutics.

[14]  A. Fakhari,et al.  Thermogelling properties of purified poloxamer 407 , 2017, Heliyon.

[15]  M. Alexander,et al.  3D printing of tablets containing multiple drugs with defined release profiles. , 2015, International journal of pharmaceutics.

[16]  Ahmad B. Albadarin,et al.  Spray drying of pharmaceuticals and biopharmaceuticals: Critical parameters and experimental process optimization approaches , 2019, European journal of pharmaceutical sciences : official journal of the European Federation for Pharmaceutical Sciences.

[17]  M. Abouzari,et al.  Triple, standard quadruple and ampicillin-sulbactam-based quadruple therapies for H. pylori eradication: a comparative three-armed randomized clinical trial. , 2006, World journal of gastroenterology.

[18]  Katarzyna Rycerz,et al.  Embedded 3D Printing of Novel Bespoke Soft Dosage Form Concept for Pediatrics , 2019, Pharmaceutics.

[19]  Seong Jun Kim,et al.  Pharmaceutical applications of 3D printing technology: current understanding and future perspectives , 2018, Journal of Pharmaceutical Investigation.

[20]  C. Almansa,et al.  Co-crystal of tramadol-celecoxib: preclinical and clinical evaluation of a novel analgesic , 2019, Expert opinion on investigational drugs.

[21]  Simon Gaisford,et al.  3D Printed Pellets (Miniprintlets): A Novel, Multi-Drug, Controlled Release Platform Technology , 2019, Pharmaceutics.

[22]  B. Blomberg,et al.  The rationale for recommending fixed-dose combination tablets for treatment of tuberculosis. , 2001, Bulletin of the World Health Organization.

[23]  M. Mahesh,et al.  Extensively drug-resistant tuberculosis in a young child after travel to India. , 2015, The Lancet. Infectious diseases.

[24]  P. Štěpánek,et al.  Combination , 1902, Definitions.

[25]  Yue Liu,et al.  Synergistic Antibacterial Activity of Designed Trp-Containing Antibacterial Peptides in Combination With Antibiotics Against Multidrug-Resistant Staphylococcus epidermidis , 2019, Front. Microbiol..

[26]  Alexander P. Haring,et al.  Programming of Multicomponent Temporal Release Profiles in 3D Printed Polypills via Core–Shell, Multilayer, and Gradient Concentration Profiles , 2018, Advanced healthcare materials.

[27]  T. De Beer,et al.  Hot-melt co-extrusion for the production of fixed-dose combination products with a controlled release ethylcellulose matrix core. , 2014, International journal of pharmaceutics.

[28]  Viness Pillay,et al.  3D printed, controlled release, tritherapeutic tablet matrix for advanced anti‐HIV‐1 drug delivery , 2019, European journal of pharmaceutics and biopharmaceutics : official journal of Arbeitsgemeinschaft fur Pharmazeutische Verfahrenstechnik e.V.

[29]  A. Healy,et al.  Personalised 3D Printed Medicines: Optimising Material Properties for Successful Passive Diffusion Loading of Filaments for Fused Deposition Modelling of Solid Dosage Forms , 2020, Pharmaceutics.

[30]  Andrea Alice Konta,et al.  Personalised 3D Printed Medicines: Which Techniques and Polymers Are More Successful? , 2017, Bioengineering.

[31]  L. Saha,et al.  Fixed dose drug combinations (FDCs): rational or irrational: a view point. , 2008, British journal of clinical pharmacology.

[32]  Jonathan Goole,et al.  3D printing in pharmaceutics: A new tool for designing customized drug delivery systems. , 2016, International journal of pharmaceutics.

[33]  E. Jawetz,et al.  The mode of action of antibiotic synergism and antagonism: the effect in vitro on bacteria not actively multiplying. , 1955, Journal of general microbiology.

[34]  A. Bansal,et al.  Coprocessing of Nevirapine and Stavudine by Spray Drying , 2008 .

[35]  Allan Clarke,et al.  Development of Liquid Dispensing Technology for the Manufacture of Low Dose Drug Products , 2017 .

[36]  E. Bissagnéné,et al.  Safety of a fixed-dose combination of artesunate and amodiaquine for the treatment of uncomplicated Plasmodium falciparum malaria in real-life conditions of use in Côte d’Ivoire , 2017, Malaria Journal.

[37]  Jukka Rantanen,et al.  Anti‐tuberculosis drug combination for controlled oral delivery using 3D printed compartmental dosage forms: From drug product design to in vivo testing , 2017, Journal of controlled release : official journal of the Controlled Release Society.

[38]  A. M. Healy,et al.  A comparative study between hot‐melt extrusion and spray‐drying for the manufacture of anti‐hypertension compatible monolithic fixed‐dose combination products , 2018, International journal of pharmaceutics.

[39]  Abdul W. Basit,et al.  Automated therapy preparation of isoleucine formulations using 3D printing for the treatment of MSUD: first single-centre, prospective, crossover study in patients. , 2019, International journal of pharmaceutics.

[40]  Cassiana Mendes,et al.  Supersaturating drug delivery system of fixed drug combination: sulfamethoxazole and trimethoprim , 2019, Expert review of anti-infective therapy.

[41]  Simon Gaisford,et al.  Direct powder extrusion 3D printing: Fabrication of drug products using a novel single-step process. , 2019, International journal of pharmaceutics.

[42]  M. Bourlière,et al.  Hepatitis C virus therapy: No one will be left behind. , 2019, International journal of antimicrobial agents.

[43]  L. Froyen,et al.  Binding Mechanisms in Selective Laser Sintering and Selective Laser Melting , 2004 .

[44]  M. Gohel,et al.  A review of co-processed directly compressible excipients. , 2005, Journal of pharmacy & pharmaceutical sciences : a publication of the Canadian Society for Pharmaceutical Sciences, Societe canadienne des sciences pharmaceutiques.

[45]  Simon Gaisford,et al.  Selective laser sintering (SLS) 3D printing of medicines. , 2017, International journal of pharmaceutics.

[46]  A. Healy,et al.  Optimising the in vitro and in vivo performance of oral cocrystal formulations via spray coating , 2018, European journal of pharmaceutics and biopharmaceutics : official journal of Arbeitsgemeinschaft fur Pharmazeutische Verfahrenstechnik e.V.

[47]  M. Alexander,et al.  3D printing of five-in-one dose combination polypill with defined immediate and sustained release profiles. , 2015, Journal of controlled release : official journal of the Controlled Release Society.

[48]  Niklas Sandler,et al.  Inkjet printing of drug substances and use of porous substrates-towards individualized dosing. , 2011, Journal of pharmaceutical sciences.

[49]  K. Eberhardt,et al.  Development and characterization of a Drop-on-Demand inkjet printing system for nuclear target fabrication , 2017 .

[50]  H. Wen,et al.  Formulation design, challenges, and development considerations for fixed dose combination (FDC) of oral solid dosage forms , 2013, Pharmaceutical development and technology.

[51]  A. Nangia,et al.  Improved Stability of Tuberculosis Drug Fixed-Dose Combination Using Isoniazid-Caffeic Acid and Vanillic Acid Cocrystal. , 2018, Journal of pharmaceutical sciences.

[52]  Kinam Park 3D printing of 5-drug polypill. , 2015, Journal of Controlled Release.

[53]  Ahmad B. Albadarin,et al.  Amorphous Solid Dispersion of Ibuprofen: A Comparative Study on the Effect of Solution Based Techniques. , 2019, International journal of pharmaceutics.

[54]  P. Wright,et al.  Anisotropic material properties of fused deposition modeling ABS , 2002 .

[55]  C. Stetler Fixed Combination Drugs , 1971, Science.

[56]  Simon Gaisford,et al.  3D Printing of a Multi-Layered Polypill Containing Six Drugs Using a Novel Stereolithographic Method , 2019, Pharmaceutics.

[57]  D. Prabhakaran,et al.  Fixed-combination, low-dose, triple-pill antihypertensive medication versus usual care in patients with mild-to-moderate hypertension in Sri Lanka: a within-trial and modelled economic evaluation of the TRIUMPH trial. , 2019, The Lancet. Global health.

[58]  S. G. da Cruz Fonseca,et al.  Use of chemometrics to compare NIR and HPLC for the simultaneous determination of drug levels in fixed‐dose combination tablets employed in tuberculosis treatment , 2018, Journal of pharmaceutical and biomedical analysis.

[59]  Abdul W. Basit,et al.  Patient acceptability of 3D printed medicines. , 2017, International journal of pharmaceutics.

[60]  A. Nangia,et al.  Cocrystals of the Tuberculosis Drug Isoniazid: Polymorphism, Isostructurality, and Stability , 2014 .

[61]  R. Chaisson,et al.  Natural history of HIV infection in the era of combination antiretroviral therapy. , 1999, AIDS.

[62]  M. Dea-Ayuela,et al.  Orally Bioavailable and Effective Buparvaquone Lipid-Based Nanomedicines for Visceral Leishmaniasis. , 2018, Molecular pharmaceutics.

[63]  M. Falagas,et al.  Clinical relevance of in vitro synergistic activity of antibiotics for multidrug-resistant Gram-negative infections: A systematic review. , 2019, Journal of global antimicrobial resistance.

[64]  E A Emini,et al.  Treatment with indinavir, zidovudine, and lamivudine in adults with human immunodeficiency virus infection and prior antiretroviral therapy. , 1997, The New England journal of medicine.

[65]  S. Naggie,et al.  Management of Hepatitis C in 2019. , 2019, JAMA.

[66]  Nathalie Gontard,et al.  Scientific Opinion of the Panel on Food Contact Materials, Enzymes, Flavourings and Processing Aids (CEF) , 2009 .

[67]  Ganjun Yuan,et al.  Synergistic combination of two antimicrobial agents closing each other’s mutant selection windows to prevent antimicrobial resistance , 2018, Scientific Reports.

[68]  A. Healy,et al.  Engineering of pharmaceutical cocrystals in an excipient matrix: Spray drying versus hot melt extrusion , 2018, International journal of pharmaceutics.

[69]  R. Collier Reducing the “pill burden” , 2012, Canadian Medical Association Journal.

[70]  Ryan B Wicker,et al.  Microstereolithography and characterization of poly(propylene fumarate)-based drug-loaded microneedle arrays , 2015, Biofabrication.

[71]  Valmik Bhavar,et al.  A review on powder bed fusion technology of metal additive manufacturing , 2017 .

[72]  R. Schlosser Fixed-Dose and Fixed-Ratio Combination Therapies in Type 2 Diabetes. , 2019, Canadian journal of diabetes.

[73]  Hauptadministrator The Data Sheet , 2016 .

[74]  M. Mickle,et al.  Formulation and processing of novel conductive solution inks in continuous inkjet printing of 3-D electric circuits , 2005, IEEE Transactions on Electronics Packaging Manufacturing.

[75]  A. Lazzarin,et al.  Access denied? The status of co-receptor inhibition to counter HIV entry , 2007, Expert opinion on pharmacotherapy.

[76]  E. Seoane-Vazquez,et al.  Fixed-dose combination and single active ingredient drugs: a comparative cost analysis , 2015, Expert review of pharmacoeconomics & outcomes research.

[77]  H. Wedemeyer,et al.  Treating viral hepatitis C: efficacy, side effects, and complications , 2006, Gut.

[78]  Alan Riboldi-Tunnicliffe,et al.  Tropoelastin Implants That Accelerate Wound Repair , 2018, Advanced healthcare materials.

[79]  W. Brett Caldwell,et al.  Multiparticulate Technologies for Fixed-Dose Combinations , 2017 .

[80]  Libin Rong,et al.  Treatment of hepatitis C virus infection with interferon and small molecule direct antivirals: viral kinetics and modeling. , 2010, Critical reviews in immunology.

[81]  Peter Timmins,et al.  From ‘fixed dose combinations’ to ‘a dynamic dose combiner’: 3D printed bi‐layer antihypertensive tablets , 2018, European journal of pharmaceutical sciences : official journal of the European Federation for Pharmaceutical Sciences.

[82]  Ferdinando Auricchio,et al.  Visible light 3D printing with epoxidized vegetable oils , 2019, Additive Manufacturing.

[83]  Anne Marie Healy,et al.  Production of cocrystals in an excipient matrix by spray drying. , 2018, International journal of pharmaceutics.

[84]  J. Aronson Medication errors resulting from the confusion of drug names. , 2004, Expert opinion on drug safety.

[85]  J. Breitkreutz,et al.  Improving Drug Delivery in Paediatric Medicine , 2012, Pharmaceutical Medicine.

[86]  J. Breitkreutz,et al.  On‐demand manufacturing of immediate release levetiracetam tablets using pressure‐assisted microsyringe printing , 2019, European journal of pharmaceutics and biopharmaceutics : official journal of Arbeitsgemeinschaft fur Pharmazeutische Verfahrenstechnik e.V.

[87]  Abdullah Isreb,et al.  ‘Temporary Plasticiser’: A novel solution to fabricate 3D printed patient‐centred cardiovascular ‘Polypill’ architectures , 2019, European journal of pharmaceutics and biopharmaceutics : official journal of Arbeitsgemeinschaft fur Pharmazeutische Verfahrenstechnik e.V.

[88]  Abdul W. Basit,et al.  Stereolithography (SLA) 3D printing of an antihypertensive polyprintlet: Case study of an unexpected photopolymer-drug reaction , 2020 .

[89]  Waqar Ahmed,et al.  Emergence of 3D Printed Dosage Forms: Opportunities and Challenges , 2016, Pharmaceutical Research.