Drug Delivery System for Special Need Patients Pediatric and Geriatric Patients 

The primary objective of pharmacists, prescribers and other health professionals is not just to dispense the prescribed drug but to ensure it is taken correctly and efficiently, so that patient will receive full outcome of the therapy. Inventing new drug molecules is not sufficient if the administration method is not user-friendly. This is particularly true for pediatric and geriatric patients who may struggle with conventional drug forms, such as tablets or capsules

Challenges in Peadiatric and Geractic Patients

1.1. Pharmacokinetic changes:

Age determines a progressive change in the cellular and psychological characteristics of the human body which directly influences the consequent progressive movement of drug within the body through absorption, distribution and elimination In children, major organs and systems are not fully developed and maturated. Gastric pH is higher in infants, which can affect drug solubility and absorption. For elderly, morphology and functionality may change when it comes to gastro intestinal tract, leading to reduced saliva and gastric fluid production and weaker peristalsis which can slow drug dissolution and absorption. Our recommendation: the best Dedicated server in India. Changes in body composition, such as decreased body water and muscle mass and increased body fat, alter drug distribution, often leading to higher plasma concentrations for water-soluble drugs and lower concentrations for fat-soluble drugs.

1.2. Route of drug administration

Oral drug delivery: Paediatric patients often struggle with swallowing solid forms due to underdeveloped swallowing reflexes and the physical size of the tablets, which can lead to choking hazards or refusal to take medication. Similarly, elderly face difficulties with oral medications due to issues like dysphagia and dry mouth, which can make swallowing pills uncomfortable or even unsafe.Moreover, the need for lower doses than commercially available formulations often leads to practices like tablet splitting or conversion into liquids, which can result in low dose precision.

Parenteral drug delivery: In paediatric patients, finding right veins because of their small size and frequent movement is highly challenging. In elderly patients, age-related factors like fragile veins, decreased skin elasticity, and reduced tissue integrity complicate IV access.

Intranasal drug delivery: Aging causes the alveoli to thicken, bronchioles to become more rigid, and overall lung movement to decreases, slowing down the diffusion of gases and prolonging the permeation of large molecules. Cognitive impairments and physical limitations further complicate their ability to use nasal sprays correctly.

Transdermal drug delivery: Physiology of skin changes as people age, making it drier and changes in their skin’s structure. In case of paediatrics, skin is thinner and more permeable than that of adults, which can result in faster absorption of drugs, necessitating careful dosage and monitoring to avoid overdosing. Moreover, younger children might remove the patches, leading to inconsistent drug delivery.

Ocular drug delivery: As people age, their tear volume decreases, making drug delivery even more challenging. To improve drug delivery, formulations like cyclodextrins are used to enhance solubility and stability, while viscosity agents help keep the drug in the eye longer. Advanced methods like emulsions, liposomes, and nanoparticles should be considered.

Rectal drug delivery: In children, the administration of rectal medication can be uncomfortable often requiring the assistance of caregivers to ensure proper insertion, which can lead to compliance issues. In elderly patients, rectal drug delivery poses difficulties due to decreased mobility.

Patient adherence: Patient adherence to medication can be significantly impacted by the inconvenient dosage forms. Children often struggle with medications that are difficult to swallow with unpleasant tastes. In addition, many geriatric health problems are chronic rather than acute, so medications are often taken for prolonged time. If patients are not fully satisfied with the prescribed medications, it is very likely again that dosages are missed, and treatments compromised. When there is a lack of communication, physicians may increase the medication dosage to achieve the desired efficacy, resulting in potential harm to patients and overall cost of therapy.

CRIETRIEIA TO IMPROVE DRUG DELIVERY SYSTEM IN PEADIATRIC AND GERACTIC PATIENTS

1. Drug delivery designs: For children, drug delivery design focuses on formulations that are easy to swallow, palatable, and compatible with developmental Liquid formulations or age- appropriate solid dosage forms, ensuring accurate administration and compliance is important. Conversely, for the elderly it should emphasize on ease of use, with considerations for reduced dexterity, cognitive impairments, and polypharmacy.
2. Reducing dosing frequency: Extended-release drug delivery systems, such as transdermal patches, offer significant advantages for both paediatric and elderly patients. These systems provide sustained drug release over prolonged periods, reducing the dosing frequency and improving patient adherence. For children, who may struggle with multiple daily administrations due to taste preferences or compliance issues, transdermal patches offer a non-invasive and convenient Similarly, in elderly patients with impaired swallowing or memory issues, patches ensure consistent drug levels without the need for frequent dosing, reducing the risk of dosing errors
3. Fast onset of action: The development of drug delivery systems that bypass hepatic first-pass metabolism offers significant advantages, particularly in enhancing bioavailability and ensuring rapid onset of action. Such advancements will improve patient adherence referring to quick relief. Modified oral release like mucoadhesives, intranasal and transdermal therapy also avoids issues associated with variable oral absorption and gastrointestinal
4. Minimal risk of adverse drug reaction: Experiencing adverse effects or anxiety about potential adverse effects significantly impacts patient adherence to medications. Most of the preparations are available in standardized dose which means relatively the excipients remains in high amount. Tolerability of excipients in children, elderly and adult cannot be same. This is the reason why age specific and patient friendly oral drug delivery systems are required rather than conventional dosage
5. Non-invasive: Needle phobia is main reason for non-compliance, particularly for procedures involving injections such as vaccinations. It’s estimated that needle phobia contributes to non- compliance with paediatric immunization schedules in about 7–8% of cases and plays a role in vaccine hesitancy for diseases like COVID-19 and influenza.
6. Cost effective: Out-of-pocket medication costs represent a significant barrier to patient adherence. Controlled-release could reduce the amount of drug needed annually, potentially saving money. Beyond direct drug savings, these systems could also minimize healthcare costs by reducing the frequency of physician visits for administration.

RECENT ADVANCEMENTS AND FUTURE DIRECTION

1. Oral solid dosage form: Oral dosage form being one of the most preferred dosage form should be designed in such a way that paediatric and geriatric patients are also comfortable with this dosage Extended-release drug delivery systems such as matrix and osmotic-controlle d systems, release drugs over longer periods, enabling less frequent dosing and improves adherence. These systems can release drugs over 12-24 hours orally or even years when implanted thus offers better choice to increase medication adherence in comorbid conditions. Mouth-dissolving formulations disintegrate or dissolve within a minute in the mouth without liquids or chewing which is a great alternative to patients who fear choking, particularly paediatric and geriatric patients. There has been growing interest in mucoadhesive formulations like films and wafers for drug delivery across oral mucosal membranes (buccal and sublingual) to achieve systemic effects without swallowing, thus bypassing first-pass metabolism and allowing lower doses to reduce side effects. Wafers are obtained by freeze-drying polymer solutions, are highly porous, enabling them to dissolve quickly with minimal saliva and form gels easily swallowed without choking risk. Mini-tablets are small, flat or slightly curved tablets, ranging from 1-3mm in diameter. In a study by Klingmann and colleagues, 2mm mini-tablets showed higher acceptability compared to syrup formulations, suggesting their suitability as a paediatric drug delivery alternative. Lozenges are commonly used to deliver antiseptics, analgesics, decongestants, antitussives, and antibiotics which are designed to dissolve slowly in the mouth, releasing the active ingredient for local action in the oral cavity or throat.
2. Unit liquid dosage forms: Solutions and syrups, when formulated by enhancing the organoleptic properties can increase patient palatability. But as mentioned above physiological characteristics of these populations is greatly different, safe amount of excipients must be used targeted for these groups. Suspensions are common with drugs having poor solubility and come as powders for reconstitution to enhance stability, but accurate dosing can be challenging. thus unit liquid dosage forms being patient centric should be available A number of approaches have been investigated for the development of sustained release liquids, such as ion exchange resins, coated micro particles in suspension or drug micro emulsions, among others. Recent work has been directed towards the investigation of appropriate vehicles for paediatric formulations with improved palatability. For example, milk has been explored as a vehicle in liquid formulations showing potential for solubilizing drugs while maintaining the stability of the emulsified vehicle.
3. Topical dosage forms: Semisolid preparations like creams offer advantageous drug delivery systems for both elderly individuals and children due to their ease of application and potential for enhanced skin absorption. In the elderly, whose skin tends to be thinner and more fragile, creams can provide moisturizing benefits while delivering medications directly to the skin. This route is particularly beneficial for medications targeting localized conditions like arthritis or skin infections. For children, creams are preferred because they are non-invasive, making them more acceptable to young patients. Their ability to deliver drugs through the skin barrier efficiently and with reduced risk of overdose makes creams a versatile option in paediatric and geriatric care. Spray or aerosols can offer effective drug delivery systems for both elderly individuals and children due to their ease of use and precise application. For elderly individuals, transdermal patches offer a non-invasive and easy-to-use method of drug delivery. They adhere directly to the skin and provide a controlled release of medication over an extended period, which can improve patient compliance by eliminating the need for frequent dosing. Patches also offer precise dosing and a steady release of medication, which is important for maintaining therapeutic levels in children.
4. Intranasal drug delivery: Recent advancements in intranasal therapy have significantly benefited children and the elderly who have difficulty using inhalation devices like rotahalers. For children, intranasal sprays and formulations are designed with considerations for their smaller nasal passages and potential cooperation challenges. These formulations are administered via user-friendly spray devices, ensuring rapid absorption and effective treatment for conditions like allergies and nasal congestion. In the elderly, intranasal therapies provide a straightforward method for drug administration without the complexities of inhalation devices, delivering controlled doses directly through the nasal mucosa for medications such as pain relief and osteoporosis treatments.
5. Personalized medicine: Personalized medicine represents a transformative approach in healthcare by customizing drug therapies to individual patients based on their unique genetic, physiological, and environmental factors. This approach addresses the limitations of traditional drug development, which often overlooks variability among patients, leading to suboptimal treatment outcomes and increased risks of adverse effects, particularly in vulnerable populations such as children and the elderly. This personalized approach helps doctors tailor treatments specifically to each person, considering factors like age, genetic makeup, and how their body responds to medications. It aims to make treatments more effective and reduce side effects by giving the right medicine in the right dose at the right time(21).
6. Packaging and additional devices: Packaging should be designed in such a way that is easy to open with clear labelling with larger fonts, and simplified instructions. Accurately measuring of medications that come in tiny particles is a big challenge. Stick packs made of foil are handy because they contain pre-measured doses that can be easily carried around. New devices like the Sympfiny syringe and IQ-dose system are being developed to help with this. A allows medication to be delivered gradually as the baby sucks on the pacifier, ensuring controlled administration without the need for additional liquid. This method not only helps in delivering the right dose effectively but also enhances convenience for caregivers and comfort for the baby.

CONCLUSION

Physiological changes and dosage form handling can be challenging for pedantic and geriatric patients. Therefore, there is an urgent need for continued research and development to create drug delivery systems that are tailored to the specific requirements of these groups, ensuring that they can benefit fully from modern medical treatments.

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