Modified protocol of omalizumab treatment to prevent carboplatin-induced drug hypersensitivity reactions:a case study

Carboplatin administration can usually be safely continued via a so-called desensitisation protocol when hypersensitivity reactions arise. Severe break-through reactions that occur early during desensitisation are likely to be IgE-mediated; in that case, addition of omalizumab premedication should be strongly considered

Performance of Tablet Splitters, Crushers, and Grinders in Relation to Personalised Medication with Tablets

Swallowing problems and the required dose adaptations needed to obtain optimal pharmacotherapy may be a hurdle in the use of tablets in daily clinical practice. Tablet splitting, crushing, or grinding is often applied to personalise medication, especially for the elderly and children. In this study, the performance of different types of (commercially available) devices was studied. Included were splitters, screwcap crushers, manual grinders, and electric grinders. Unscored tablets without active ingredient were prepared, with a diameter of 9 and 13 mm and a hardness of 100–220 N. Tablets were split into two parts and the difference in weight was measured. The time needed to pulverise the tablets (crush time) was recorded. The residue remaining in the device (loss) was measured. The powder was sieved to obtain a particle fraction >600 µm and <600 µm. The median particle size and particle size distribution of the later fraction were determined using laser diffraction analysis. Splitting tablets into two equal parts appeared to be difficult with the devices tested. Most screwcap grinders yielded a coarse powder containing larger chunks. Manual and especially electric grinders produced a finer powder, making it suitable for administration via an enteral feeding tube as well as for use in individualised preparations such as capsules. In conclusion, for domestic and incidental use, a screwcap crusher may provide sufficient size reduction, while for the more demanding regular use in hospitals and nursing residences, a manual or electric grinder is preferred

Inhalation manoeuvre performed by Parkinson's patients during an off period

Objective: To assess the ability of Parkinson's patients to perform an inhalation manoeuvre correctly during an off period. Background: Due to the expected faster onset of effect compared to oral levodopa, administration of levodopa via a dry powder inhaler is an interesting alternative to oral levodopa in Parkinson's patients in an off period. During an off period, the motor function is impaired and the patient is suffering from symptoms like bradykinesia, tremor and rigidity. Little is known about the ability to use dry powder inhalers during an off period. We studied the inspiratory flow manoeuvre performed by Parkinson's patients in an off period. Methods: After informed consent was obtained, 13 Parkinson's patients in an off period simulated inhalation manoeuvres through a testinhaler, with 3 different resistances to air flow. These resistances to air flow are considered medium/high to high, according to the ERS/ISAM task force consensus statement. With the obtained flow curves, we calculated various inhalation parameters. Results: The mean PIF and its ranges were found to increase with decreasing resistance to air flow. The average inhaled volume was > 2 L, for all three resistances to air flow. The total inhalation time and time to PIF were found to decrease with decreasing resistance to air flow. Twelve out of thirteen patients were able to hold their breath for at least 5 seconds after inhalation. Nine of them were able to extend the breath hold time to 10 seconds. Conclusions: Most Parkinson's patients demonstrated the ability to perform an inhalation manoeuvre that is expected to be sufficient for the successful use of a dry powder inhaler by this particular patient group