1. Controlled drug release
Dr Mohammad Issa

2. Frequency of dosing and therapeutic index
Therapeutic index (TI) is described as the ratio of the maximum drug conc in the blood that can be tolerated to the minimum drug conc needed to produce a satisfactory clinical response. In some cases these ranges are narrow, resulting in small therapeutic index
We seek to maintain drug conc in blood within the Therapeutic range during therapy. This requires not only the selection of an appropriate daily dose, the drug must also be given with sufficient frequency so as to minimize the range of blood conc that are produced. The ratio of max to minimum drug conc at steady state should not exceed the therapeutic index of the drug.

3. Frequency of dosing and therapeutic index
For drugs that are absorbed and distributed rapidly, the following relation apply

4. Frequency of dosing and therapeutic index
A drug with the TI of 2, t1/2 of 3 hrs must be given no less frequently than every 3 hours
A drug with similar half life but a therapeutic index of 4 may be given every 6 hours

5. Absorption rate and frequency of dosing
Dosing regimen for rapidly absorbed drugs are a function of the pharmacodynamics and pharmacokinetics of the drug molecule, they must be based on the therapeutic index and half life of the drug
Reducing the absorption rate of a drug by controlling the rate of drug release in the dosage form, can dramatically affect drug conc at steady state
For a given formula, the slower the release of the drug, the smaller is the ratio of maximum to minimum drug con at steady state. Under these conditions, we can give larger doses at less frequent intervals and still stay within the therapeutic conc of the drug

6. Absorption rate and frequency of dosing
Prolonged release medication offer obvious advantages for drugs with short half lives and narrow therapeutic indices. As they permit the drug to be given at more reasonable intervals within the day (improve patient compliance)
They also minimize the peak to trough drug conc ratio, which may be useful for many drugs.
For example: potassium depleting hydrocholrthiazides: their potassium depleting effect disappears when the fluctuations in blood levels decrease. Nephrotoxicity of gentamicin is reduced when steady state conc are reached and maintained in a narrow range.

7. Zero order release
Continuous, constant rate IV infusion leads to constant blood levels. Under these conditions blood levels are invariant with time, there are no peaks and troughs
Provided that the constant drug conc is within the therapeutic range, this is an ideal situation for many drugs
The only way to achieve constant blood levels is to administer the drug at a constant (zero-order) rate over the entire dosing interval.

8. Zero order release
Fluctuations in blood levels do occur as a result of transient changes in clearance or in the delivery rate, but they are usually small
Constant rate release is not limited to infusion, today there are dosage forms oral, ocular, intravaginal, IM that release the drug in a zero order or near zero order fashion.

9. Oral prolonged release medications
Most prolonged release medications are intended for oral use. A prolonged release unit usually contains more drug than a conventional dosage unit, but it intended to be given less frequently
A drug that is usually administered at a dose of 250 mg 4 times daily, may be given at a dose of 500 mg twice daily, or 1 gm once daily

10. Oral prolonged release medications
The ultimate criteria of for evaluating such dosage forms are:
the amount of drug intended to be absorbed is indeed absorbed in a predictable and consistent manner
the steady state ratio of maximum to minimum drug conc is no greater or optimally less than that produced by the more frequently administered conventional dosage forms

11. Potential advantages oral prolonged release medications
Improved control of the maintenance therapuetic level of the drug which permit:
improved treatment of many chronic illnesses where symptoms breakthrough occurs if plasma levels went down (asthma, depression)
maintenance of the therapeutic action during night (management of pain)
reduction in the incidence and severity of side effects caused by increased plasma levels
improved patient compliance
reduction of the incidence and severity of gastrointestinal side effects caused by irritant drugs administered in a conventional dosage form

12. Potential limitations oral prolonged release medications
variable physiological factors (gastric emptying, gastric and intestinal transit rate, food) which often influence drug bioavailability of conventional dosage form may also interfere with the precision of control of release of the SR dosage forms
the rate of transit of the sustained release oral dosage form along the GI limits the maximum period of time for which the therapeutic response is maintained
Sustained release dosage forms which tend to remain intact, may become lodged at some sit of the GI--- slow release, high localized conc of drug, local irritation

13. Potential limitations oral prolonged release medications
Reduced potential for accurate dosage adjustment: fine dose adjustment is difficult.
Dose dumping: uncontrolled rapid release of the drug material due to failure of the formulation which result in abnormal high blood levels of circulating drug