From ‘fixed dose combinations’ to ‘a dynamic dose combiner’: 3D printed bi‐layer antihypertensive tablets

ABSTRACT There is an increased evidence for treating hypertension by a combination of two or more drugs. Increasing the number of daily intake of tablets has been reported to negatively affect the compliance of patients. Therefore, numerous fixed dose combinations (FDCs) have been introduced to the market. However, the inherent rigid nature of FDCs does not allow the titration of the dose of each single component for an individual patient's needs. In this work, flexible dose combinations of two anti‐hypertensive drugs in a single bilayer tablet with a range of doses were fabricated using dual fused deposition modelling (FDM) 3D printer. Enalapril maleate (EM) and hydrochlorothiazide (HCT) loaded filaments were produced via hot‐melt extrusion (HME). Computer software was utilised to design sets of oval bi‐layer tablets of individualised doses. Thermal analysis and x‐ray diffractometer (XRD) indicated that HCT remained crystalline in the polymeric matrix whilst EM appeared to be in an amorphous form. The interaction between anionic EM and cationic methacrylate polymer may have contributed to a drop in the glass transition temperature (Tg) of the filament and obviated the need for a plasticiser. Across all tablet sets, the methacrylate polymeric matrix provided immediate drug release profiles. This dynamic dosing system maintained the advantages of FDCs while providing a superior flexibility of dosing range, hence offering an optimal clinical solution to hypertension therapy in a patient‐centric healthcare service. Graphical abstract Figure. No Caption available.

[1]  M. Peeters,et al.  Effectiveness and safety of a generic fixed-dose combination of nevirapine, stavudine, and lamivudine in HIV-1-infected adults in Cameroon: open-label multicentre trial , 2004, The Lancet.

[2]  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.

[3]  A. Garber,et al.  Efficacy of glyburide/metformin tablets compared with initial monotherapy in type 2 diabetes. , 2003, The Journal of clinical endocrinology and metabolism.

[4]  A. Basit,et al.  Effect of geometry on drug release from 3D printed tablets. , 2015, International journal of pharmaceutics.

[5]  R. Manzo,et al.  Interaction between Eudragit® E100 and anionic drugs: addition of anionic polyelectrolytes and their influence on drug release performance. , 2011, Journal of pharmaceutical sciences.

[6]  N. Fan,et al.  Viewing Molecular and Interface Interactions of Curcumin Amorphous Solid Dispersions for Comprehending Dissolution Mechanisms. , 2017, Molecular pharmaceutics.

[7]  S. Pocock,et al.  to improve adherence : results from FOCUS ( Fixed-dose Combination Drug for Secondary Cardiovascular Prevention ) Project , 2014 .

[8]  M. A. Alhnan,et al.  A flexible-dose dispenser for immediate and extended release 3D printed tablets. , 2015, European journal of pharmaceutics and biopharmaceutics : official journal of Arbeitsgemeinschaft fur Pharmazeutische Verfahrenstechnik e.V.

[9]  C Vervaet,et al.  Co-extrusion as manufacturing technique for fixed-dose combination mini-matrices. , 2012, European journal of pharmaceutics and biopharmaceutics : official journal of Arbeitsgemeinschaft fur Pharmazeutische Verfahrenstechnik e.V.

[10]  B. Pharm.,et al.  THE BRITISH PHARMACOPOEIA. , 1964, The Medical annals of the District of Columbia.

[11]  Waqar Ahmed,et al.  Adaptation of pharmaceutical excipients to FDM 3D printing for the fabrication of patient-tailored immediate release tablets. , 2016, International journal of pharmaceutics.

[12]  D. S. Bell Combine and conquer: advantages and disadvantages of fixed‐dose combination therapy , 2013, Diabetes, obesity & metabolism.

[13]  R. Manzo,et al.  Enhanced intestinal permeability and oral bioavailability of enalapril maleate upon complexation with the cationic polymethacrylate Eudragit E100. , 2014, European journal of pharmaceutical sciences : official journal of the European Federation for Pharmaceutical Sciences.

[14]  P. Nandy,et al.  Analysis of dose–response in flexible dose titration clinical studies , 2012, Pharmaceutical statistics.

[15]  A. Basit,et al.  3D printing of modified-release aminosalicylate (4-ASA and 5-ASA) tablets. , 2015, European journal of pharmaceutics and biopharmaceutics : official journal of Arbeitsgemeinschaft fur Pharmazeutische Verfahrenstechnik e.V.

[16]  B. Arafat,et al.  A Lower Temperature FDM 3D Printing for the Manufacture of Patient-Specific Immediate Release Tablets , 2016, Pharmaceutical Research.

[17]  S. Bangalore,et al.  Fixed-dose combinations improve medication compliance: a meta-analysis. , 2007, American Journal of Medicine.

[18]  Y. Gupta,et al.  Fixed dose drug combinations: Issues and challenges in India , 2016, Indian journal of pharmacology.

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

[20]  Waqar Ahmed,et al.  Channelled tablets: An innovative approach to accelerating drug release from 3D printed tablets , 2018, Journal of controlled release : official journal of the Controlled Release Society.

[21]  K. Fukushige,et al.  3D Printing Factors Important for the Fabrication of Polyvinylalcohol Filament-Based Tablets. , 2017, Biological & pharmaceutical bulletin.

[22]  M. A. Alhnan,et al.  Fabrication of extended-release patient-tailored prednisolone tablets via fused deposition modelling (FDM) 3D printing. , 2015, European journal of pharmaceutical sciences : official journal of the European Federation for Pharmaceutical Sciences.

[23]  Hao Pan,et al.  Preparation and investigation of controlled-release glipizide novel oral device with three-dimensional printing. , 2017, International journal of pharmaceutics.

[24]  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.

[25]  A. Basit,et al.  Fused-filament 3D printing (3DP) for fabrication of tablets. , 2014, International journal of pharmaceutics.

[26]  Hugh Smyth,et al.  3D Printing technologies for drug delivery: a review , 2016, Drug development and industrial pharmacy.

[27]  Basel Arafat,et al.  Fabricating a Shell-Core Delayed Release Tablet Using Dual FDM 3D Printing for Patient-Centred Therapy , 2016, Pharmaceutical Research.

[28]  Shun-Li Wang,et al.  Eudragit E Accelerated the Diketopiperazine Formation of Enalapril Maleate Determined by Thermal FTIR Microspectroscopic Technique , 2004, Pharmaceutical Research.

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

[30]  D. Dollimore,et al.  A THERMAL ANALYSIS STUDY OF THE DECOMPOSITION OF HYDROCHLOROTHIAZIDE , 2002 .

[31]  H. Woerle,et al.  Initial combination of linagliptin and metformin improves glycaemic control in type 2 diabetes: a randomized, double‐blind, placebo‐controlled study , 2012, Diabetes, obesity & metabolism.

[32]  Xiangrong Zhang,et al.  A promising choice in hypertension treatment: Fixed-dose combinations , 2014 .

[33]  F. Zannad,et al.  Benefits, challenges, and registerability of the polypill. , 2006, European heart journal.

[34]  Wei Xu,et al.  Structure determination of enalapril maleate form II from high-resolution X-ray powder diffraction data. , 2003, Journal of pharmaceutical sciences.

[35]  R. Hatcher THE UNITED STATES PHARMACOPEIA. , 1908 .

[36]  Basel Arafat,et al.  A Lower Temperature FDM 3 D Printing for the Manufacture of Patient Specific Immediate Release , 2019 .

[37]  S. Onoue,et al.  Physicochemical and pharmacokinetic characterization of amorphous solid dispersion of tranilast with enhanced solubility in gastric fluid and improved oral bioavailability. , 2012, Drug metabolism and pharmacokinetics.

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