Dose dumping

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Dose dumping is a phenomenon of drug metabolism in which environmental factors can cause the premature and exaggerated release of a drug. This can greatly increase the concentration of a drug in the body and thereby produce adverse effects or even drug-induced toxicity. [1]

Contents

Dose dumping is most commonly seen in drugs taken by mouth and digested in the gastrointestinal tract. Around the same time patients take their medication, they can also ingest other substances like fatty meals or alcohol that increase drug delivery. The substances may act on the drug's capsule to speed up drug release, or they may stimulate the body's absorptive surfaces to increase the rate of drug uptake.

Dose dumping is a disadvantage found in extended release dosage form.

In general, drug companies try to avoid drugs with significant dose dumping effects. Such drugs are prone to problems and are often pulled from the market. Such was the case with the pain medication Palladone Once Daily formulation due to its dose-dumping effects when taken with alcohol. [2]

Types of dose dumping

Alcohol-induced dose dumping (AIDD)

It is by definition an unintended rapid release in large amounts of a modified-release dosage due to a co-ingestion with ethanol. [3]

Some interactions between alcohol, biological factors and the presentation of the drug can influence the apparition of AIDD by:

Food-induced dose dumping (FIDD)

Food intake produces dynamic changes in digestion and pharmacokinetics through a variety of mechanisms, which can produce an unintended release of modified-release dosages under certain circumstances. Usually, high fat diets are the most associated with this phenomenon, but there is evidence that standard-composition food can cause this even in immediate release formulations, such as the case of methylphenidate. [9]

Some of the mechanisms involved in FIDD are: [10] [11]

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References

  1. Hendeles L, Weinberger M, Milavetz G, Hill III M, Vaughan L (1985). "Food-induced "dose-dumping" from a once-a-day theophylline product as a cause of theophylline toxicity". Chest. 87 (6): 758–765. doi:10.1378/chest.87.6.758. PMID   3996063. A landmark 1985 study on dose dumping observed when theophylline was taken with fatty meals.
  2. Palladone Pain Drug Pulled Off the Market as reported by WebMD in July 2005.
  3. D’Souza, Susan; Mayock, Stephen; Salt, Alger (2017-06-07). "A review of in vivo and in vitro aspects of alcohol-induced dose dumping". AAPS Open. 3 (1). doi: 10.1186/s41120-017-0014-9 . ISSN   2364-9534.
  4. Johnson, Franklin K.; Ciric, Sabrina; Boudriau, Sophie; Kisicki, James; Stauffer, Joseph (May 2012). "Effects of Alcohol on the Pharmacokinetics of Morphine Sulfate and Naltrexone Hydrochloride Extended Release Capsules". The Journal of Clinical Pharmacology. 52 (5): 747–756. doi:10.1177/0091270011403740. ISSN   0091-2700. PMID   21593282. S2CID   5978463.
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  6. Fagerberg, Jonas H.; Al-Tikriti, Yassir; Ragnarsson, Gert; Bergström, Christel A.S. (2012-06-20). "Ethanol Effects on Apparent Solubility of Poorly Soluble Drugs in Simulated Intestinal Fluid". Molecular Pharmaceutics. 9 (7): 1942–1952. doi:10.1021/mp2006467. ISSN   1543-8384. PMID   22651218.
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