3. PARENTERALS
para: outside
enteron: intestine (i.e. beside the intestine)
These are the preparations which are given other than oral
routes.
Injections:
These are
Sterile,
Pyrogen free preparations intended to be administered
parenterally (outside alimentary tract).
4. Why Parenteral?
Parenteral Route Is Used bcoz
1) Rapid action
2) Oral route can not be used
3) Not effective except as injection
4) Many new drugs particularly those derived from new
development in biotechnologically can only be given by
parenteral coz they are inactivated in GIT if given orally.
5) New drugs require to maintain potency & specificity
sodium that they are given by parenteral.
5. Advantages:
Quick onset of action
Suitable for the drugs which are not administered by oral route
Useful for unconscious or vomiting patients.
Duration of action can be prolonged by modifying formulation.
Suitable for nutritive like glucose & electrolyte.
Suitable for the drugs which are inactivated in GIT or HCl (GI
fluid)
6. Disadvantages:
Once injected cannot be controlled (retreat)
Injections may cause pain at the site of injection
Only trained person is required
If given by wrong route, difficult to control adverse effect
Difficult to save patient if overdose
Sensitivity or allergic reaction at the site of injection
Requires strict control of sterility & non pyrogenicity than
other formulation.
7. Necessities of Parenteral preparations:
Sterility (must)
Pyrogen (must)
Free from particulate matter (must)
Clarity (must)
Stability (must)
Isotonicity (should)
Solvents or vehicles used must meet special purity and other standards.
Restrictions on buffers, stabilizers, antimicrobial preservative. Do not use
coloring agents.
Must be prepared under aseptic conditions.
Specific and high quality packaging.
10. Subcutaneous (SC; SQ ;Sub Q):
The injection is given under the skin
Need to be isotonic
Upto 2 ml is given
Using ½ to 1 inch 23 gauge needle or smaller needle
Given:
Vaccines
Insulin
Scopolamine
Epinephrine
11. Intramuscular (IM):
Striated muscle fibre
0.5 to 2 ml sometimes upto 4 ml
1 to 1.5 inch & 19 to 22 gauge needle is used
Preferably isotonic
Principle sites:
Gluteal (buttocks)
Deltoid (upper arms)
Vastus lateralis (lateral thigh)
Given:
Solutions
Emulsions
Oils
Suspension
12. Intravenous (IV):
Into the vein
1 to 1000 ml
1 inch ,19 to 20 gauge needle with injection rate 1ml/ 10 sec.
for volume upto 5 ml & 1 ml/ 20 sec. for volume more than 5
ml.
Given:
Aqueous solutions
Hydro alcoholic solutions
Emulsions
Liposome
13. IV infusion of large volume fluids (100- 1000 ml) has
become increasingly popular. This technique is called as
Venoclysis.
This is used to supply electrolytes & nutrients to restore
blood volume & to prevent tissue dehydration.
Combination of parenteral dosage forms for administration
as a unit product is known as an IV admixture.
Lactated Ringer Injection USP
NaCl Injection USP (0.9 %)– (replenish fluid & electrolyte)
Dextrose Injection USP (fluid & electrolyte)
14. Intra-arterial (IA):
Direct into the artery
2 to 20 ml
20 to 22 gauge
Solutions & emulsions can be administered
Given:
Radio opaque media
Antineoplastic
Antibiotics
15. Intrathecal:
Also called intra-spinal
Directly given into the spinal cord
1 to 4 ml
24 to 28 gauge
Must be isotonic
Given:
LA
Analgesics
Neuroleptics
16. Intraarticular:
Given directly into the joints
2 to 20 ml
5 inch 22 gauge
Must be isotonic
Given:
Morphine
LA
Steroids
NSAID’s
Antibiotics
17. Intrapleural:
Given directly into the pleural cavity or lung
Used for fluid withdrawal
2 to 30 ml
2 to 5 inch, 16 to 22 gauge needle
Given:
LA
Narcotics
Chemotherapeutic agents
18. Intracardial:
Directly given into the heart
0.2 to 1 ml
5 inch , 22 gauge needle
Given:
Cadiotonics
Calcium salts as a calcium channel blockers
19. Intradermal:
Also called as diagnostic testing
0.05 ml
½ inch, 25 to 26 gauge needle
Should be isotonic
Given:
Diagnostic agents
20. Official Types of Injections:
1. Solutions of Medicinal
Example: Codeine Phosphate Injection
Insulin Injection
2. Dry solids or liquid concentrate does not contain diluents
etc.
Example: Sterile Ampicillin Sodium
3. If diluents present, referred to as.....for injection
Example: Methicillin Sodium for injection
21. 4. Suspensions
"Sterile....Suspension"
Example: Sterile Dexamethasone Acetate Suspension
5.Dry solids, which upon the addition of suitable vehicles yield
preparations containing in all respects to the requirements
for sterile suspensions.
Title: Sterile....for Suspension
Example: Sterile Ampicillin for Suspension
6. Injectable Emulsions:
Example: Propofol injection
22. Formulation of Parenteral:
1. Therapeutic agents
2. Vehicles
i. Water
ii. Water miscible vehicles
iii. Non- aqueous vehicles
3. Added substances (Additives)
i. Antimicrobials
ii. Antioxidants
iii. Buffers
iv. Bulking agents
v. Chelating agents
vi. Protectants
vii. Solubilizing agents
viii. Surfactants
ix. Tonicity- adjusting agents
23. General steps involved
1. Cleaning
2. Preparation of bulk products
3. Filtration
4. Filling of solution in or product in ampoule or vial
5.Sealing
6. Sterilization
7. Tests for Quality control
25. Formulation of Parenteral
2.Solvents:
o Water
o Should meet compendial requirements
o Water miscible vehicles
o Ethyl alcohol
o PEG
o PG
o Non aqueous vehicles
o Fixed oils
26. Formulation of Parenteral
Solvents
Solvents used must be:
Non-irritating
Non-toxic
Non-sensitizing
No pharmacological activity of its own
Not affect activity of medicinal
27. Formulation of Parenteral
3. Added substances (Additives)
Antimicrobials:
Added for fungistatic or bacteriostat action or concentration
Used to prevent the multiplication of micro-organisms
Ex..
Benzyl alcohol ------ 0.5 – 10 %
Benzethonium chloride -- 0.01 %
Methyl paraben ---- 0.01 – 0.18 %
Propyl paraben --- 0.005 – 0.035 %
Phenol --- 0.065 – 0.5 %
28. Preservatives: Multidose containers must have
preservatives unless prohibited by monograph.
Large volume parenteral must not contain preservative becoz
it may be dangerous to human body if it contain in high
doses.
29. Antioxidants:
Used to protect product from oxidation
Acts as reducing agent or prevents oxidation
Ex:
A) Reducing agent:
o Ascorbic acid -- 0.02 – 0.1 %
o Sodium bisulphite-- 0.1 – 0.15 %
o Sodium metabisulphite-- 0.1 – 0.15 %
o Thiourea - 0.005 %
B) Blocking agents:
o Ascorbic acid esters- 0.01 – 0.015%
o BHT- 0.005 – 0.02 %
C) Synergistic:
o Ascorbic acid , Citric acid , Tartaric acid
D) Chelating agent:
o EDTA- 0.01- 0.075 %
30. Buffers:
Added to maintain pH,
Change in pH may causes degradation of the products
Acetates, citrates, phosphates are generally used.
Factors affecting selection of buffers:
Effective range,
Concentration
Chemical effect on the total product
EXAMPLES:
Acetic acid ,adipic acid, benzoic acid, citric acid, lactic acid
Used in the conc. of 0.1 to 5.0 %
31. Chelating agents:
Used to form the complex with the metallic ions present in
the formulation so that the ions will not interfere during
mfg. of formulation.
They form a complex which gets dissolved in the solvents.
Examples:
Disodium edetate – 0.00368 - .05 %
Disodium calcium edetate - 0.04 %
Tetrasodium edetate – 0.01 %
32. Stabilizers:
As parenterals are available in solution form they are most
prone to unstabilize
Used to stabilize the formulation
Maintain stable
Examples:
Creatinine – 0.5- 0.8 %
Glycerin – 1.5 – 2.25 %
Niacinamide – 1.25 -2.5 %
Sodium saccharin – 0.03 %
Sodium caprylate – 0.4 %
33. Solubilizing agents:
Used to increase solubility of slightly soluble drugs
they acts by any one of the following:
solubilizers,
emulsifiers or
wetting agents.
Examples:
Dimethylacetamide,
Ethyl alcohol
Glycerin
Lecithin
PEG – 40 castor oil
PEG – 300
Polysorbate 20, 40, 80
34. Tonicity- adjusting agents:
Used to reduce the pain of injection.
Buffers may acts as tonicity contributor as well as
stabilizers for the pH.
Isotonicity depends on permeability of a living
semipermaeable membrane
Hypotonic : swelling of cells (enlargement)
Hypertonic: shrinking of cells (reduction)
Example:
Glycerin
Lactose
Mannitol
Dextrose
Sodium chloride
Sorbitol
35. LABELING:
Name of product
Quantity of the product
% of drug or amount of drug in specified volume of amount of
drug and volume of liquid to be added
Name and quantity of all added substances
Mfg. license no.
Batch no.
Manufacturer/Distributor
Mfg. & Expiration date
Retail price (incl. of all taxes)
Mfger. address
Veterinary product should be so labeled
36. Must check each individual monogram for:
Type of container:
Glass
Plastic
Rubber closure
Type of glass
Type I
Type II
Type III
NP
Tests for glass containers
Powdered Glass test
Water Attack test
Package size
Special storage instructions
39. LAY OUT OF PARENTERAL MANUFACTURING AREA
S COMPOUNDING ASEPTIC QUARANTINE
T AREA AREA AREA
O
C STORAGE
K
AND
R TRANSPORT
O
O PACKING
M CLEAN UP
STERILIZATION AND
AREA
LABELLING
40. Clean- up area:
Non aseptic area
Free from dust ,fibres & micro-organisms
Constructed in such a way that should withstand moisture,
steam & detergent
Ceiling & walls are coated with material to prevent
accumulation of dust & micro-organisms
Exhaust fans are fitted to remove heat & humidity
The area should be kept clean sodium that to avoid
contamination to aseptic area
The containers & closures are washed & dried in this area.
41. Preparation area:
The ingredients are mixed & preparation is prepared for filling
Not essential that the area is aseptic
Strict precaution is taken to prevent contamination from
outside
Cabinets & counters: SS
Ceiling & walls : sealed & painted
42. Aseptic area:
Filtration & filling into final containers & sealing is done
The entry of outside person is strictly prohibited
To maintain sterility, special trained persons are only allowed
to enter & work
Person who worked should wear sterile cloths
Should be subjected for physical examination to ensure the
fitness
Minimum movement should be there in this area
Ceiling & walls & floors : sealed & painted or treated with
aseptic solution and there should not be any toxic effect of this
treatment
43. Cabinets & counters: SS
Mechanical equipments : SS
AIR:
Free from fibres, dust & micro organisms
HEPA filters are used which removes particles upto 0.3 micron
Fitted in laminar air flow system, in which air is free from dust & micro
organisms flows with uniform velocity
Air supplied is under positive pressure which prevents particulate
contamination from sweeping
UV lamps are fitted to maintain sterility
44. Quarantine area:
After filling, sealing & sterilization the products or batch is kept
in this area
The random samples are chosen and given for analysis to QC
dept.
The batch is send to packing after issuing satisfactory reports of
analysis from QC
If any problem is observed in above analysis the decision is to
be taken for reprocessing or others..
45. Finishing and packaging area:
After proper label, the product is given for packing
Packing is done to protect the product from external
environment
The ideal Packing is that which protects the product during
transportation, storage, shipping & handling.
The labeled container should be packed in cardboard or plastic
containers
Ampoules should be packed in partitioned boxes.
46. Preparations for IV Fluids:
LVP’s which are administered by IV route are commonly
called as IV fluids.
Purposes :
Body fluids,
Electrolyte replenisher
Volume supplied:
100 to 1000 ml
47. Precautions / necessities in mfg.:
Free from foreign particles
Free from micro organisms
Isotonic with body fluids
As they are in LVP no bacteriostatic agents are added
Free from pyrogens
48. Examples:
Dextrose injection IP : available in 2 , 5 , 10 , 25 & 50 % w/v
solution.
Used for
Fluids replenisher,
Electrolyte replenisher
Sodium chloride & Dextrose injection IP: (DNS)
Contains
0.11 to 0.9 % Sodium chloride
2.5 to 5.0 % Dextrose
Used for
Fluids replenisher,
Electrolyte replenisher
Nutrient replenisher
49. Sodium chloride injection IP:
0.9 % conc.
Also known as normal saline solution
Used as
Isotonic vehicle
Fluids replenisher,
Electrolyte replenisher
Sodium lactate injection IP:
Contains 1.75 to 1.95 % w/v of sodium lactate
Used as
Fluids replenisher,
Electrolyte replenisher
50. Mannitol injection IP:
Contains 5, 10 , 15, 20 % of mannitol
Used as :
Diagnostic aid
Renal function determination
As a diuretic
Mannitol & Sodium chloride injection IP:
Contains 5, 10 , 15, 20 % of mannitol & 0.45 % of Sodium
chloride
Used as :
As a diuretic
51. Other solutions:
Ringer injection IP
Ringer lactate solution for injection IP
Common uses :
Used in surgery patients
In replacement therapy
Providing basic nutrition
For providing TPN
As a vehicle for other drug subs.
52. IV ADMIXTURES
Definition:
When two or more sterile products are added to an IV fluid for
their administration, the resulting combination is known as IV
admixture.
In hospitals, prepared by nurses by combining or mixing drugs
to the transfusion fluids.
The drugs are incorporated in to bottles of LV transfusion
fluids.
53. Care :
Microbial contamination
Incompatibility
Physical : change in color
Chemical : hydrolysis, oxidation, reduction etc..
Therapeutic: undesirable antagonistic or synergistic effect
54. Methods for safe & effective use of IV admixture:
Proper training to nurses & pharmacist
Instruction regarding labeling
Information for stability & compatibility to the hospital
pharmacy dept.
Information for the formulation skills to the pharmacist.
55. Total Parenteral Nutrition
TPN stands for Total Parenteral Nutrition. This is a complete form
of nutrition, containing protein, sugar, fat and added vitamins and
minerals as needed for each individual.
Total Parenteral Nutrition (TPN) may be
defined as provision of nutrition for metabolic
requirements and growth through the parenteral route.
56. Total Parenteral Nutrition (TPN)
(Intravenous Nutrition)
TPN refers to the provision
of all required nutrients,
exclusively by the
Intravenous route.
Parenteral Nutrition (PN)can be used to supplement ordinary
or tube feeding.
57. Components of TPN solutions:
(1) Protein as crystalline amino acids.
(2) Fats as lipids.
(3) Carbohydrate as glucose.
(4) Electrolytes–Sodium, potassium, chloride, calcium and
magnesium.
(5) Metals/Trace elements–Zinc, copper, manganese,
chromium, selenium.
(6) Vitamins A, C, D, E, K, thiamine, riboflavin, niacin,
pantothenic acid, pyridoxine, biotin, choline and folic acid.
58. Why it is necessary?
TPN might be necessary if:
a patient is severely undernourished, and needs to have
surgery, radiotherapy or chemotherapy;
a patient suffers from chronic diarrhea and vomiting;
a baby's gut is too immature;
a patient's (their "gastrointestinal tract") is paralysed, for
example after major surgery.
59. Normal Diet TPN
Protein…………Amino Acids
Carbohydrates…Dextrose
Fat……………..Lipid Emulsion
Vitamins………Multivitamin Infusion
Minerals………Electrolytes & Trace Elements
61. Total Parenteral Nutrition
Electrolytes
Electrolyt Daily Requirement Standard Concentration
e.
Na 60-150 meq 35-50 meq/L
K 40-240 meq 30-40 meq/L
Ca 3-30 meq 5 meq/L
Mg 10-45 meq 5-10 meq/L
Phos. 30-50 mM 12-15 mM/L
62. When is it necessary?
TPN is normally used following surgery, when feeding by
mouth or using the gut is not possible,
When a person's digestive system cannot absorb nutrients
due to chronic disease, or, alternatively, if a person's
nutrient requirement cannot be met by enteral feeding (tube
feeding) and supplementation.
63. Short-term TPN may be used if a person's digestive
system has shut down (for instance by Peritonitis), and
they are at a low enough weight to cause concerns about
nutrition during an extended hospital stay.
Long-term TPN is occasionally used to treat people
suffering the extended consequences of an accident or
surgery.
Most controversially, TPN has extended the life of a
small number of children born with nonexistent or
severely birth-deformed guts.
64. GENERAL INDICATIONS
Patient who can’t eat
Patient who won’t eat
Patient who shouldn’t eat
Patient who can’t eat enough
“If the gut works, use it.”
65. NOMENCLATURE
TPN: Total Parenteral Nutrition
IVH: Intravenous Hyperalimentation
TNA: Total Nutrient Admixture
TPN: Total Parenteral Nutrition
3-In-1 Admixture
All-In-One Admixture
PPN: Peripheral Parenteral Admixture
66. Indications for TPN
Short-term use
Bowel injury /surgery
Bowel disease
Severe malnutrition
Nutritional preparation prior to surgery.
Malabsorption - bowel cancer
Long-term use
Prolonged Intestinal Failure
Crohn’s Disease
Bowel resection
67. The preferred method of delivering TPN is with a
medical infusion pump.
A sterile bag of nutrient solution, between 500 mL and
4 L is provided.
The pump infuses a small amount (0.1 to 10 mL/hr)
continuously in order to keep the vein open.
Feeding schedules vary, but one common regimen
ramps up the nutrition over a few hours, levels off the
rate for a few hours, and then ramps it down over a few
more hours, in order to simulate a normal set of meal
times.
68. The nutrient solution consists of water, glucose, salts, amino
acids, vitamins and (more controversially) sometimes
emulsified fats.
Long term TPN patients sometimes suffer from lack of trace
nutrients or electrolyte imbalances. Because increased blood
sugar commonly occurs with TPN, insulin may also be added
to the infusion.
Often though, an insignificant amount of insulin is added,
sometimes 10 units or less in 2 liters of TPN.
In actuality, the patient will probably get less than that.
Occasionally, other drugs are added as well, sometimes
unnecessarily.
69. Complications of TPN
Sepsis
Air embolism
Clotted catheter line
Catheter displacement
Fluid overload
Hyperglycaemia
Rebound Hypoglycaemia
70. DIALYSIS FLUIDS
Dialysis is the process in which substances are
separated from one another due to their
difference in diffusibility (distribution) thr’
membrane.
The fluids used in dialysis are known as dialysis
fluids.
71. General uses :
Renal failure
waste product is removed
Maintain electrolytes
Also called as haemodialysis or intraperitoneal dialysis
Transplantation of kidney
Poisoning cases
72. Haemodialysis:
To remove toxins from blood
In haemodialysis, the blood from artery is passed thr’ artificial
dialysis membrane, bathed in dialysis fluid.
The dialysis membrane is permeable to urea, electrolytes &
dextrose but not to plasma proteins & lipids
So excess of urea is passed out from blood thr’ dialysis fluid.
73. After dialysis blood is returned back to the body circulation
thr’ vein.
A kidney unit may require more than 1200 litres of solution /
week.
So haemodialysis fluid is prepared in conc. Form then it is
diluted with deionised water or dist. water before use.
74. COMPOSITION
Composition of Concentrated Haemodialysis Fluid BPC
Dextrose monohydrate ----------- 8.0 gm
Sodium acetate --------------------- 19.04 gm
Lactic acid --------------------------- 0.4 ml
Sodium chloride ------------------- 22.24 gm
Potassium chloride --------------- 0.4 gm
Freshly boiled & cooled water -q.s. 100 ml
Dilute 1 liter of conc. solution with 39 liters of water to make 40 litres.
Storage: store in warm place as it is liable to convert into crystals on storage.
75. Intraperitoneal Dialysis:
Peritoneal cavity is irrigated with dialysis fluid.
Peritoneum acts as a semi permeable membrane
Toxic subs. excreted by kidney are removed.
Requirements:
Sterile
Pyrogen free
76. COMPOSITION
Composition of Fluid Intraperitoneal Dialysis IP
1985
Sodium chloride ------------------- 5.56 gm
Sodium acetate --------------------- 4.76 gm
Calcium chloride ------------------- 0.22 gm
Magnesium chloride -------------- 0.152 gm
Sodium metabisulphite ---------- 0.15 gm
Dextrose (anhydrous) ----------- 17.30 gm
Purified water -----------q.s.----- 1000 ml
Sterilize by autoclave immediately after
preparation.
78. 1. Sterility testing - definition
Sterility testing attempts to reveal the presence or absence of
viable micro-organisms in a sample number of containers
taken from batch of product. Based on results obtained from
testing the sample a decision is made as to the sterility of the
batch.
79. Sterility testing -
is made after the product exposition to the one of the
possible sterilization procedures
can only provide partial answers to the state of sterility of the
product batch under test
is inadequate as an assurance of sterility for a terminally
sterilized product
80. Major factors of importance in sterility
testing
The environment in which the test is conducted
The quality of the culture conditions provided
The test method
The sample size
The sampling procedure
81. 1.1.Environmental conditions
avoid accidental contamination of the product during the test
the test is carried out under aseptic conditions
regular microbiological monitoring should be carried out
85. 1.2.2. Phases of bacterial growth
Lag phase (A)
Log (logarithmic or
exponential) phase (B)
Stationary phase (C)
Decline (death) phase (D)
86.
87. 1.2.3.Culture media for sterility testing
capable of initiating and maintaining the vigorous growth of a
small number of organisms
sterile
Types of media:
Fluid thioglycollate medium
Soya-bean casein digest medium
other media
88. 1.2.3.1.Fluid thioglycollate medium
composition described in next slide.
specific role of some ingredients
primarily intended for the culture of anaerobic bacteria
incubation of the media:
14 days at 30 -35°C
90. 1.2.3.2.Soya-bean casein digest medium
primarily intended for the culture of both fungi and aerobic
bacteria
specific role of some ingredients
incubation of the media:
14 days at 20 -25°C
92. 1.2.3.3.Fertility control of the media
are they suitable for growth of each micro-organism?
'Growth promotion test for aerobes, anaerobes and fungi' ;
inoculation of media tubes with a MO
incubation (T, t)
the media are suitable if a clearly visible growth of the micro-
organisms occurs
93. 1.2.3.4.Effectiveness of the media under
test conditions
are culture conditions satisfactory in the presence of the
product being examined?
comparing the rate of onset and the density of growth of
inoculated MO in the presence and absence of the material
being examined
growth control;
94. 1.3.The test method for sterility of the
product
Membrane filtration
Direct inoculation of the culture medium
95. 1.3.1. Membrane filtration
Appropriate for : (advantage)
filterable aqueous preparations
alcoholic preparations
oily preparations
preparations miscible with or soluble in aqueous or oily (solvents
with no antimicrobial effect)
solutions to be examined must be introduced and filtered
under aseptic conditions
All steps of this procedure are performed aseptically in a
Class 100 Laminar Flow Hood
96. 1.3.1.1.Selection of filters for membrane
filtration
pore size of 0.45 µm
effectiveness established in the retention of micro-organisms
appropriate composition
the size of filter discs is about 50 mm in diameter
97. 1.3.1.2.The procedure of membrane
filtration
sterilization of filtration system and membrane
filtration of examined solution under aseptic conditions
(suitable volume, dissolution of solid particles with suitable
solvents, dilution if necessary…)
one of two possible following procedures:
the membrane is removed, aseptically transferred to container of
appropriate culture medium
passing the culture media through closed system to the
membrane, incubation in situ in the filtration apparatus (sartorius,
millipore).
98.
99. 1.3.2.Direct inoculation of the culture
medium
suitable quantity of the preparation to be examined is
transferred directly into the appropriate culture medium
volume of the product is not more than 10% of the volume
of the medium
suitable method for aqueous solutions, oily liquids,
ointments an creams
100. Scheme for sterility test by membrane filtration Scheme for sterility test by direct inoculation
101. Advantages of the filtration method
wide applications
a large volume can be tested with one filter
smaller volume of culture media is required
applicable to substances for which no satisfactory inactivators
are known
neutralization is possible on the filter
subculturing is often eliminated
shorter time of incubation compared with direct inoculation
102. 1.4. Observation and interpretation of
the results
Examination at time intervals during the incubation period
and at its conclusion
When the sample passes the test and when fails?
When the test may be considered as invalid?
There is low incidence of accidental contamination or false
positive results
105. Instead of the conclusion - Guidelines for
using the test for sterility
Precautions against microbial contamination
The level of assurance provided by a satisfactory result of a
test for sterility as applied to the quality of the batch is a
function of:
The homogeneity of the batch
The conditions of manufacture
Efficiency of the adopted sampling plan
106. Guidelines …
In the case of terminally sterilized products: physical
proofs, biologically based and automatically
documented, showing correct treatment through the
batch during sterilization are of greater assurance than
the sterility test
Products prepared under aseptic conditions: sterility test is
the only available analytical method
only analytical method available to the authorities who have
to examine a specimen of a product for sterility.
109. Pyrogens
Pyrogenic - means producing fever
Pyrogens - fever inducing substances
Having nature
Endogenous (inside body)
Exogenous (outside body)
Exogenous pyrogens –
mainly lipopolysaccharides
bacterial origin, but not necessary
110. Structure of endotoxins
Produced mostly by gram-negative bacteria
Endotoxin - complex of pyrogenic lipopolysaccharide, a
protein and inert lipid;
lipid part of the lipopolysaccharide is the main pyrogenic
agent; polysaccharide part increases solubility
114. Sources of pyrogen contamination
solvent - possibly the most important source
the medicament
the apparatus
the method of storage between preparation and sterilization
116. Tests for pyrogenic activity
Test for pyrogens = Rabbit test
Bacterial endotoxins
117. Test for pyrogens = Rabbit test
the development of the test for pyrogens reach in 1920
a pyrogen test was introduced into the USP XII (1942)
The test consists of measuring the rise in body temperature
in healthy rabbits by the intravenous injection of a sterile
solution of the substance under the test.
118. Why the Rabbit?
Reproducible pyrogenic response
Other species not predictable
Rabbit vs. dog as model?
Rabbits: false positives
Dogs: false negatives
Similar threshold pyrogenic response to humans
119. Rabbit Pyrogen Test
Rabbits must be healthy and mature
New Zealand or Belgian Whites used
Either sex may be used
Length of use
>48 hours within negative result
>2 weeks within a positive result
Must be individually housed between 20 and 23°C
120. Rabbit test -
selection of animals (healthy, adult, not less than 1,5 kg,
…)
housing of animals (environmental problems: presence
of strangers (unknown place), noise, T, …)
equipment and material used in test (glassware,
syringes, needles)
retaining boxes (comfortable for rabbits as possible)
thermometers (standardized position in rectum,
precision of 0.1°C)
121.
122. Rabbit test
Preliminary test (Sham Test)
intravenous injection of sterile pyrogen-free saline solution
to exclude any animal showing an unusual response to the
trauma (shock) of injection
any animal showing a temperature variation greater than
0.6°C is not used in the main test
123. Rabbit test -
main test:
group of 3 rabbits
preparation and injection of the product:
warming the product
dissolving or dilution
duration of injection: not more than 4 min
the injected volume: not less than 0.5 ml per 1 kg and not more than
10 ml per kg of body mass
determination of the initial and maximum temperature
all rabbits should have initial T: from 38.0 to 39.8°C
the differences in initial T should not differ from one another by more
than 1°C
124. Rabbit test
Interpretation of the results:
the test is carried out on the first group of 3 rabbits; if
necessary on further groups of 3 rabbits to a total of 4 groups,
depending on the results obtained
intervals of passing or failing of products are on the basis of
summed temperature response
125. The result of pyrogen test:
No.of Rabbits Individual Tempt. Test
Tempt. rise Rise in
(°c) group (°c)
3 rabbits 0.6 1.4 Passes
If above not passes 0.6 3.7 Passes
3+5 = 8 rabbits
If above test not passes perform the test again
If above test not passes, the sample is said to be pyrogenic
or go thr’ the sources of contamination of pyrogen.
126. Bacterial endotoxins
to detect or quantify endotoxins of gram-negative
bacterial origin
reagent: amoebocyte lysate from horseshoe crab
(Limulus polyphemus or Tachypleus tridentatus).
The name of the test is also Limulus amebocyte lysate
(LAL) test
128. Mechanism of LAL
the test is based on the primitive blood-clotting mechanism of
the horseshoe crab
enzymes located with the crab's amebocyte
blood cells
endotoxins
initiation of an enzymatic coagulation cascade
proteinaceous gel
129. Commercially derived LAL reagents
bleeding adult crabs into an anticlotting solution
washing and centrifuging to collect the amebocyte
lysing in 3% NaCl
lysate is washed and lyophilized for storage
activity varies on a seasonal basis and standardization is
necessary.
130. Test performance (short)
avoid endotoxin contamination
Before the test:
interfering factors should not be present
equipment should be depyrogenated
the sensitivity of the lysate should be known
Test:
equal V of LAL reagent and test solution (usually 0.1 ml of each)
are mixed in a depyrogenated test-tube
incubation at 37°C, 1 hour
remove the tube - invert in one smooth motion (180°) - read
(observe) the result
pass-fail test
131. LAL test
Three different techniques:
the gel-clot technique - gel formation
the turbidimetric technique - the development of
turbidity after cleavage of an endogenous substrate
the chromogenic technique - the development of color
after cleavage of a synthetic peptide-chromogen complex
132. LAL test
6 methods with different steps of accuracy of LAL test
results:
Method A: gel-clot method: limit test
Method B: gel-clot method: semi-quantitative test
Method C: turbidimetric kinetic method
Method D: chromogenic kinetic method
Method E: chromogenic end-point method
Method F: turbidimetric end-point method
In the event of doubt or dispute, the final decision is made
upon Method A unless otherwise indicated in the
monograph.
133. Gel-cloth technique (Methods A, B)
allows detection or
quantification of endotoxins Gel Clot
clotting of the lysate in the
presence of endotoxins.
1.Preparatory testing
Confirmation of the labeled
lysate sensitivity
Tests for interfering factors
Invert Tube in Smooth
Motion
134. Gel-cloth technique (Methods A, B)-cont.
2. Limit test (method A)
procedure described on page. 24
a firm gel - positive result.
an intact gel is not formed - negative result.
the interpretation of the results
3. Semi-quantitative test (method B)
quantification of bacterial endotoxins in the test solution by titration
to an end-point.
procedure is similar as in the limit test
The results are expressed as concentration of endotoxin as
less, equal or greater than λ (labeled lysate sensitivity).
135. Turbidimetric technique (Methods C, F)
photometric test to measure the increase in turbidity
end-point test (Method F): quantitative relationship between
the endotoxin concentration and the turbidity (absorbance or
transmission) of the reaction mixture at the end of an incubation
period.
kinetic test (Method C): a method to measure either the time
(onset time) needed for the reaction mixture to reach a
predetermined absorbance, or the rate of turbidity development.
136. Chromogenic technique (Methods D, E)
measuring the chromophore released from a suitable
chromogenic peptide by the reaction of endotoxins with
the lysate
end-point test (Method E): is based on the quantitative
relationship between the endotoxin concentration and the
quantity of chromophore released at the end of an incubation
period
kinetic test (Method D): a method to measure either the time
(onset time) needed for the reaction mixture to reach a
predetermined absorbance, or the rate of color development
137. Instead of the conclusion - Guidelines for
test for bacterial endotoxins
the absence of bacterial endotoxins in a product implies
the absence of pyrogenic component
if you wish to replace rabbit test you should prove that
you don’t have interfering factors
if rabbit pyrogen test is replaced by endotoxin test, the
last one should be validated
methods from C to F require more instrumentation, but
they are easier to automate
test for bacterial endotoxins is preferred over the test for
pyrogens
138. Advantages of LAL test
Fast - 60 minutes vs. 180 minutes
Greater Sensitivity
Less Variability
Much Less False Positives
Much Less Expensive
Alternative to Animal Model
cheaper,
more accurate than other
is performed in the pharmaceutical laboratory
specific for endotoxins of gram-negative origin
particularly useful for:
Radiopharmaceuticals and cytotoxic agents
Products with marked pharmacological or toxicological activity in the
rabbit (e.g. insulin)
Blood products which sometime give misleading results in the rabbit
Water for injection where LAL test is potentially more stringent and
readily applied
140. Definition:
Unwanted mobile insoluble matter other than gas bubbles
present in the given product.
It may be dangerous when the particle size is larger than
R.B.C. & may block the blood vessel.
This type of products are immediately rejected from the
batch.
141. The limit test for particulate matter is prescribed in I.P.
1996 (A- 125)
Applicable for:
100 ml or more volume containers of single dose LV given by IV
infusion
Not applicable for:
Multidose injections
Single dose SVP
Injectable solutions constituted from sterile solids
142. Permitted limits of particulate matter
Particle size in micrometer Max.No.of particles
(equal to or larger than) per ml
10 50
25 5
50 Nil
143. Sources of particulate matter
Contamination
Contaminant
Intrinsic contamination:
Originally present in products
e.g. Barium ions may react or leach with Sulphur ion which are already
present in formulation may produce barium sulphate crystals.
144. Extrinsic contamination:
Material comes from outside or environment
e.g. coming off the material from body & cloths of person
Entry of particle from ceiling , walls & furniture
May be in the form of cotton, glass rubber, plastics, tissues, insect
fragments, bacterial contamination, dust, papers etc…
146. Visual method:
Simple method
Filled container are examined against strong illuminated screen by
holding neck & rotating it slowly or inverted it to keep out the
foreign matter.
Coulter counter method:
It is used for detection of particles less than 0.1 micrometer in
diameter.
Based on electrode resistance.
Sample is evaluated between two electrode & if particle found the
resistance of electrode is increased.
147. Filtration method:
It is used for counting the particles in hydraulic fluids.
Sample passed thr’ filter
Material is collected on filter
Evaluated under microscope.
Disadvantage:
Skilled & trained person is required
Light blockage method:
Used for hydraulic oils
Allows stream of fluid under test to pass between a bright white
light source & photoiodide sensor.
148. Identification of Particulate Matter
Microscopy
X- ray powder diffraction
Mass microscopy
Microchemical tests
Electron microscopy etc…
149. Significance of Particulate Matter
monitoring
Its presence may causes:
Septicemia
Fever & blockage of blood vessels
Quality of product may affect
150. As per USP
LVP : NMT 50 particles/ ml (size 10 or more than 10 micrometer)
& 5 particles/ ml (size more than 25 micrometer)
SVP: 10,000 particles/ container of size 10 micrometer or greater
& NMT 1000 particles/ container greater than 25 micrometer.
Monkeys, horses, dogs, cats, and rabbit have reproducible responses Rats, guinea pigs, mice, hamsters, chicks, etc, are irregular and unpredictable Rabbit and dog chosen chosen for economic purposes, BUT… Rabbit has labile thermoregulatory process, and is susceptible to false positives. A negative test is more significant than a positive one. The dog has a more stable thermoregulatory system, and is less sensitive to pyrogen. Therefore a positive is more significant than a negative one. Similar threshold pyrogenic response to humans. HOWEVER, as dose is increased, humans respond more vigorously.
USP XX had only two requirements for the animals, that they be healthy and mature. NZ or Belgian Whites are mostly used Either sex may be used, but kept to a single sex to avoid outside stimuli