IntroductionMedication adherence is a critical global challenge because suboptimal adherence reduces therapeutic efficacy and increases healthcare costs. While leftover drugs are vital indicators of potential adherence-related challenges, age-specific factors contributing to their occurrence, particularly across the lifespan, remain insufficiently understood. This study was aimed at clarifying age-stratified factors associated with leftover drugs using large-scale objective data from protocol-based pharmacotherapy management (PBPM) in community pharmacies.MethodsThis was a single-center, retrospective, observational cohort study of 36,340 outpatients. Objective reporting of data based on the PBPM in community pharmacies between 2016 and 2021 was analyzed. Multivariate logistic regression and predicted probability models were used to evaluate the interactions between age (decade-stratified) and four primary clinical factors: drug count, prescription duration, prescribing department count, and sex.ResultsThe overall proportion of leftover drugs was 9.6% (n = 3,472). In the overall population comparison, no significant differences were observed in terms of sex, but the patients in the leftover group were significantly older and had higher medication counts, longer prescription durations, and more prescribing departments. Multivariate analysis revealed significant interactions between age and each of the three primary prescription-related factors. The impact of clinical characteristics on the proportion of leftover drugs varied distinctly across life stages. Specifically, long-term prescription was the most potent risk factor for younger adults (20s–40s), whereas polypharmacy and multidepartment visits were the primary factors associated with leftover drugs for older patients. Predicted probability models indicated that having fewer than five prescribed medications was consistently associated with a lower likelihood of leftover drugs across all age groups.ConclusionThis study highlights the influence of clinical characteristics on leftover drug shifting substantially with age. Consequently, effective management requires age-specific interventions centered on minimizing drug counts, with an emphasis on optimizing prescription duration in younger adults and promoting medication simplification and inter-institutional coordination in older adults.
BackgroundThe pharmaceutical industry faces a productivity crisis, with only ∼10% of candidates reaching approval and development costs exceeding $1-2 billion per drug. Traditional preclinical models, particularly animal studies, show limited predictive validity for human outcomes. Microphysiological systems (MPS), including organ-on-chip devices, integrated with digital twin computational modeling, offer a promising route to improve translational prediction, yet no systematic assessment exists.ObjectivesTo identify, evaluate, and synthesize the published literature on integrating MPS with digital twin computational modeling for pharmaceutical development.MethodsFollowing PRISMA 2020 guidelines (PROSPERO: CRD420251274941), PubMed and Europe PMC were searched from January 2010 to December 2025. Studies were included if they integrated MPS platforms with computational models (PBPK, QSP, IVIVE, PK/PD, or machine learning). Two-stage automated screening with independent verification by two researchers was applied. Data extraction captured organ systems, model types, platforms, validation approaches, pharmacokinetic parameters, software, and economic considerations.ResultsOf 2,044 records, 123 studies met inclusion criteria. Publication activity grew exponentially (CAGR ∼35%), with 38.2% published in 2024–2025. Liver was the most represented organ (30.9%), followed by vasculature (19.5%), gut (18.7%), and immune components (17.1%). PBPK was the predominant computational approach (18.7%), followed by PK (12.2%), IVIVE (12.2%), and machine learning (9.8%). Commercially, Emulate led (55.8%), then Mimetas (23.3%) and CN Bio (19.2%); custom/academic platforms comprised 74.2%. Validation was robust, with 95.8% discussing clinical data comparisons and 77.5% reporting average fold error. Only liver-PBPK and liver-PK qualified as established combinations (>5 studies), with many organ-model pairings unexplored. Multi-organ systems showed accelerating adoption after 2021. Economic themes were discussed qualitatively, but formal health economic analyses were absent.ConclusionMPS-digital twin integration has matured from an emerging concept into a research paradigm with demonstrated translational value. Validation practices are strong and aligned with regulatory expectations, supported by the FDA Modernization Act 2.0 and the ISTAND program’s acceptance of Liver-Chip technology. Liver-focused applications are the most mature and should serve as a template for expansion. Priority gaps include kidney, lung, and brain MPS-computational integration, multi-organ systems, and rigorous health economic analyses. Continued standardization and regulatory engagement will be essential to realize this approach’s potential.
Ophthalmic diseases are a growing global cause of visual impairment, driven by population aging and the rising prevalence of diabetes mellitus. Fenofibrate, a peroxisome proliferator-activated receptor alpha (PPARα) agonist widely used for dyslipidemia, has emerged as a candidate for therapeutic repurposing in ophthalmology. This narrative review synthesizes current preclinical and clinical evidence on fenofibrate across anterior and posterior segment diseases, including diabetic corneal neuropathy, diabetic keratopathy, dry eye disease, corneal burns, Fuchs endothelial corneal dystrophy, diabetic retinopathy, diabetic macular edema, neovascular age-related macular degeneration, and central retinal artery occlusion. Across ocular disease models, fenofibrate demonstrates neuroprotective, vascular stabilizing, and tissue-remodeling effects. These actions appear to involve modulation of shared pathogenic pathways, including PPARα-dependentregulation of inflammatory signaling, mitochondrial and lipid metabolism, and preservation of epithelial, endothelial, neuronal, and vascular integrity. Clinical evidence is strongest for diabetic retinopathy, where randomized trials support a potential adjunctive role in slowing progression and reducing interventions in patients with early-to-moderate disease. Preliminary clinical evidence for diabetic corneal neuropathy is promising but limited, whereas data for dry eye disease, corneal burns, Fuchs endothelial corneal dystrophy, neovascular age-related macular degeneration, and retinal ischemic injury remains preclinical. Emerging experimental ocular delivery strategies may improve local bioavailability while reducing systemic exposure. Overall, fenofibrate represents a biologically plausible adjunctive ophthalmic therapy, but further randomized trials, mechanistic studies, pharmacokinetic evaluation, and long-term safety assessments are required to define its therapeutic role beyond diabetic retinopathy.
The kidney plays a critical role in metabolite excretion, fluid regulation, and homeostasis, yet remains highly vulnerable to structural and functional disorders. Kidney diseases represent a major global health burden, often progressing to chronic complications due to the limited efficacy and poor selectivity of conventional therapies, which are frequently associated with systemic toxicity. Accordingly, the development of targeted drug delivery systems is essential to improve therapeutic outcomes. In this study, advanced quatsomes were developed as a kidney-targeted nanosystem to enhance the delivery of curcumin, a natural polyphenolic compound with potent antioxidant and nephroprotective properties. The system was composed of di-dodecyl-dimethyl-ammonium bromide (DDAB), cholesterol, limonene, hyaluronic acid (HA) and surfactants, and was fabricated using the ethanol injection method. A 23 factorial design was employed to optimize formulation variables, including DDAB:cholesterol ratio, limonene:drug ratio, and surfactant concentration. The optimized formulation (desirability = 0.950) exhibited high entrapment efficiency (87.80%), nanosized vesicles (120.55 nm), and a positive surface charge (+38.30 mV). Transmission electron microscopy confirmed spherical morphology, while in-vitro release studies demonstrated a biphasic profile. The formulation also showed good physicochemical stability and enhanced antioxidant activity. Mechanistically, passive targeting via nanoscale size and cationic charge facilitated interaction with the glomerular filtration barrier and mesangial uptake, while limonene improved vesicle deformability. HA functionalization further enabled CD44-mediated active targeting. In vivo, the optimized system significantly reduced serum creatinine and blood urea nitrogen levels in a cisplatin-induced nephrotoxicity model, with histological evidence of renal protection. Overall, the developed quatsomes demonstrate promising potential as an efficient renal-targeted nanocarrier.
PurposeDrug-Related Problems (DRPs) are a leading cause of preventable harm to hospitalized children, yet the data from low- and middle-income countries (LMICs) are limited. This study aimed to determine the prevalence, severity and determinants of DRPs in children with community-acquired infections (CAIs) using standard classification, and to quantify clinical and economic impact of pharmacist-led interventions.MethodsA prospective interventional study conducted (June 2024-March 2025), in pediatric ward of tertiary care public hospital, Karachi, Pakistan. Children aged 2months-14 years with CAIs were enrolled. A trained pharmacist reviewed medication orders daily, identifying DRPs (classified by PCNE V9.1 and severity by NCC MERP criteria). Interventions were proposed to physicians and acceptance rates recorded. Direct cost savings were calculated and DRP predictors were identified using logistic regression.ResultsA total of 3,842 medication orders were reviewed for 400 patients, identifying 2,010 DRPs (5.03 DRPs/patient). Primary causes were dose-selection (C3-58.13%), drug-form (C2-15.01%), and drug-selection (C1-13.08%). Severity assessment classified 9.0% of errors as having potential to cause serious harm. Pharmacist interventions had 98.7% acceptance and 81.1% DRPs were resolved. Number of medications (AOR 1.32), fever (AOR 2.84) and length of stay >7days (AOR 1.76) were identified as predictors of DRPs; past immunization was protective (AOR 0.51). Direct cost saving was PKR 363,184 (USD1,290) over 10 months (23:1 cost ratio). Cost per DRP prevented was PKR 241 (USD 0.86), with 142% return on investment.ConclusionDRPs affected 52.3 per 100 medication orders in hospitalized children with CAIs, with dose selection DRPs predominant and 9% having serious harm potential. Pharmacist-led interventions demonstrated a 98.7% acceptance rate and 81.1% resolution of DRPs, and were associated with substantial cost savings, providing evidence for integrating clinical pharmacy services in LMICs.
The growing number of pandemics and emergencies traversing the world in recent decades has illustrated the vulnerability of the conventional pharmaceutical development process and the necessity of an efficient, robust, and patient-driven pandemic-ready development model. QbD is a scientifically proven proactive approach that has been comprehensively examined recently for its potential to effectively optimize formulations in an accelerated time frame. Risk factor assessment and constant surveillance serve to maintain the product quality & standards before the final stage of large-scale production and offer regulatory pliability. The extension of this method, AQbD, paired side by side also assists in accelerated assessment and quality assurance which is a critical component in any global circumstance. In recent years studies have been done by applying this novel approach, but very little has been reported on the establishment of this approach as a Pandemic-Ready Development Framework. This mini review addresses the regulatory basis alongside the key principles of QbD, which aligns its working approach as optimally compatible with any pandemic situation. Furthermore, it emphasizes the widespread implementation of this approach as AQbD, which stands for swift testing coupled with quality assurance standards. It also focuses on the limitations and critical areas where QbD can be applied to cope with existing demands in near future. Further, it applies this approach in several formulation developments pertinent to pandemic or endemic conditions and discusses the challenges of implementation and future directions. Overall, this discussion stresses the potential of this approach as a very promising framework for future pandemics.
The serine/threonine kinase glycogen synthase kinase-3 (GSK-3) was initially identified and studied in the regulation of glycogen synthesis. In some cases, suppression of GSK-3 activity by phosphorylation by Akt and other kinases has been associated with cancer progression. In these cases, GSK-3 has tumor suppressor functions. In other cases, GSK-3 has been associated with tumor progression by stabilizing components of the beta-catenin complex. In these situations, GSK-3 has oncogenic properties. The Raf kinase inhibitor protein (RKIP) has been reported to be under expressed in many cancers and plays a role in the regulation of tumor cells’ survival, proliferation, invasion, and metastasis, hence, a tumor suppressor. RKIP also regulates tumor cell resistance to cytotoxic drugs/cells. Likewise, the tumor suppressor, phosphatase and tensin homolog (PTEN), which inhibits the phosphatidylinositol 3 kinase (PI3K)/protein kinase B (Akt) pathway, is either mutated, under expressed, or deleted in many cancers and shares with RKIP its anti-tumor properties and its regulation in resistance. Several pathways are regulated by RKIP, GSK-3, PTEN, and the transcriptional and post-transcriptional regulations of RKIP, GSK-3, and PTEN are significantly altered in cancers. In addition, RKIP, GSK-3 and PTEN play a key role in the regulation of tumor cells response to chemotherapy and immunotherapy. In this review, we will focus on the roles that GSK-3, PTEN, and RKIP play in various human cancers. We will also discuss how this pivotal kinase interacts with multiple signaling pathways such as: PI3K/PTEN/Akt/mechanistic target of rapamycin complex 1 (mTORC1), nuclear Factor kappa-B (NF-κB)/Snail family transcriptional repressor 1 (Snail)/Yin Yang 1 (YY1) loop, and rat sarcoma virus oncogene (Ras)/rapidly accelerated fibrosarcoma (Raf)/mitogen-activated protein kinase (MEK)/extracellular signal-regulated kinase (ERK).
Antimicrobial resistance (AMR) is a globally accelerating issue threatening the efficacy of existing treatments. Repurposing approved drugs for the development of new antimicrobial agents reduces the development cost and risk. The clinical potential of repurposed medications for AMR is essential to implement coordinated strategies that encompass scientific validation and supportive regulatory frameworks. Repurposing serves as a strong method to prolong the effectiveness of current antimicrobial classes and to fill significant voids in the global AMR pipeline. The present review summarizes current trends in repurposing strategies against AMR, utilization of non-antibiotic drugs with antibacterial activity, agents that potentiate conventional antibiotics through membrane disruption or efflux pump inhibition, and host-directed therapies that modulate immune responses and combination therapies. We also highlight advances in systems pharmacology, in silico screening, and phenotypic assays that enable rational identification of repurposing candidates. Although significant regulatory and economic barriers persist, including weak intellectual property protection, limited commercial incentives, and market constraints, swift attempts are being made to address the issues.
ObjectivesDissolution and/or release profile alone are insufficient to predict the in vivo absorption of poorly soluble drugs. Thus, permeation test becomes a critical component for biopharmaceutical assessment. Currently, none of the dissolution-permeation systems include the compendial dissolution, or provide large acceptor volumes, or are compatible with ex vivo membranes. Addressing the limitations of the existing dissolution-permeation testing systems, we propose the integration of the Ussing (permeability) chamber to the dissolution apparatus.MethodsThe assembled dissolution-permeation system evaluated the effect of 5% and 10% soy L-α-phosphatidylcholine in dodecane (LiDo) and permeable membrane material on apparent permeability coefficients of naproxen, a BCS II class drug.ResultsNaproxen release from the tablets reached approximately 100% within 30 min. Naproxen Papp across a 0.45 µm PVDF membrane was 0.91 ± 0.35 × 10-8 cm/s for 5% LiDo, and 0.75 ± 0.23 × 10-8 cm/s for 10% LiDo. The 0.20 μm PC membrane with 5% LiDo showed a Papp of 1.99 ± 0.57 × 10-8 cm/s.ConclusionThe proposed compendial dissolution-permeation system with an Ussing chamber allowed for the simultaneous determination of dissolution and permeability of naproxen. All Papp values obtained were approximately 100-fold lower than those reported in the literature. The results may have been influenced by the differences in sink conditions and permeable membrane composition. The use of a PC membrane resulted in higher permeability, compared to the PVDF membrane. Adequately improved, this methodology could be transferred for the ex vivo membrane dissolution-permeability testing.
Topical roflumilast, available in 0.3% cream, 0.15% cream, and 0.3% foam formulations, is a novel, highly potent phosphodiesterase-4 (PDE4) inhibitor that was recently approved in Canada for the treatment of plaque psoriasis, atopic dermatitis, and seborrheic dermatitis, respectively. Topical formulations were shown in clinical trials to significantly improve disease symptoms with excellent tolerability and minimal adverse events. An oral form of roflumilast has also been approved in Canada since 2010 for the maintenance treatment of chronic obstructive pulmonary disease. The product monograph for topical roflumilast currently references a substantial amount of safety information specific to the oral formulation due to a lack of long-term safety data. Furthermore, no formal drug-drug interaction studies have been conducted with topical roflumilast, nor in special populations in whom oral roflumilast is contraindicated. Due to the impact that the route of administration has on the pharmacokinetic profile of a drug and its subsequent ability to produce undesirable or toxic effects, this presents a challenge for pharmacists who are tasked with determining how to best interpret and communicate this safety information to patients. This paper reviews the safety information contained within the product monograph for topical roflumilast in the context of the pharmacokinetic differences between the topical and oral formulations. The impact of the route of administration on adverse effect risk, drug-drug interactions, and contraindications is highlighted, and practical guidance is provided to assist pharmacists in interpreting and applying this information in practice.
Artificial intelligence (AI) directed computational protein design has emerged as a transformative force in modern therapeutic discovery, reshaping how vaccines and antibody-based interventions are conceived, optimized, and deployed against emerging infectious diseases. The COVID-19 pandemic served as an unprecedented real-world stress test for these technologies, highlighting their potential to accelerate antigen design, guide antibody optimization, and anticipate viral evolution in near real time. AI driven approaches contributed to faster characterization of viral variants, supported vaccine and broadly neutralizing antibodies developments. Despite the significant contributions, the pandemic also revealed important limitations that must be addressed before such approaches can be relied upon as cornerstones of global preparedness. Challenges related to data bias, model interpretability, experimental validation bottlenecks, and integration with existing regulatory frameworks became increasingly apparent. In several cases, the gap between computational promise and translational readiness underscored the need for closer coupling between in silico design, laboratory experimentation, and clinical evaluation. Moreover, the rapid pace of AI innovation often outstripped established regulatory pathways, raising questions about standardization, validation, and long-term safety. This mini review provides a focused overview of recent advances in AI enabled computational protein design, with an emphasis on applications relevant to pandemic response. Drawing on lessons from COVID-19 case studies, it examines translational and regulatory considerations, highlights unresolved controversies, and identifies critical research gaps. Collectively, these insights outline a path toward transitioning AI designed vaccines and antibody therapeutics from reactive emergency tools into proactive, scalable infrastructures for future pandemic preparedness.
BackgroundFrankincense (gum olibanum, Boswellia spp.) is an oleo-gum resin widely used in traditional medicine and cosmetics owing to the presence of volatile oils and pentacyclic triterpenic acids (boswellic acids) with reported anti-inflammatory and antioxidant properties.ObjectivesThe aim of this study was to extract and characterize oil- and water-soluble fractions of frankincense resin, evaluate their antioxidant potential, and incorporate them into a stable water-in-oil (w/o) nourishing/antiaging cream.MethodsFrankincense resin was ground and macerated separately in sweet almond oil and Madinah rosewater to yield oil and water infusions, respectively. Qualitative phytochemical tests and FT-IR spectroscopy were employed for the characterization of both extracts and final formulations. Antioxidant potential was assessed using the DPPH assay followed by the development of a w/o cream (beeswax:almond oil:rosewater base) using combined infusions, which was evaluated for pH, viscosity, phase separation, spreadability, and thermal stability.ResultsPhytochemical screening showed presence of triterpenoids and boswellic type functionalities predominantly in the oil infusion, whereas saponins and minor alkaloids were detected in the water infusion. In the DPPH assay, significant free radical scavenging activity was observed as sample 2 showed 71% inhibition at 343.46 ± 34.2 μg/mL. The developed cream formulation showed good physical stability, acceptable pH and shear-thinning rheology.ConclusionA stable, all-natural w/o cream formulation was developed incorporating combined oil- and water-soluble frankincense infusions. Future studies are warranted to perform quantitative chemical analysis, in vitro skin permeation, and formal skin safety testing to ensure uninform active content, good bioavailability and tolerability prior to clinical studies.
Methamphetamine (METH)-induced agitation, a major concern in acute METH intoxication, is currently treated with benzodiazepines. Due to current polysubstance use patterns in METH consumption, this treatment may fatally exacerbate respiratory depression produced by opioid adulterants or intentionally co-administered opioids. We previously showed that the α2-agonist dexmedetomidine (DEX), which does not potentiate opioid-induced respiratory depression in clinical practice, can be safely and effectively co-administered with naloxone to attenuate METH-induced agitation following naloxone reversal in METH-fentanyl co-intoxicated rats. While the unique arousability of DEX-induced sedation is clinically useful, the current study tested the safety and efficacy of DEX and adjunctive ketamine (KET) in producing deeper, less arousable sedation when needed (i.e., for severe agitation or to facilitate an intricate procedure). Fifteen minutes after 1 mg/kg METH administration in male rats (simulating treatment of naloxone-unmasked agitation with a delay), low-dose (0.032 mg/kg) DEX ± (56 mg/kg) KET, high-dose (0.18 mg/kg) DEX, or saline was administered. Key measurements included METH-induced locomotor activity (a rat model of agitation), the rat coma scale (a quantification of arousability), and α2-agonist class side effects. Both high-dose DEX and DEX-KET almost completely attenuated METH-induced locomotor activity for 90 min after administration, but with the combination the sedation was deeper during the most intense METH-induced stimulation, and the α2-agonist side effects were less intense and of shorter duration. These data provide proof-of-concept support for the potential use of DEX-KET in producing deeper sedation in METH-induced agitation.
ObjectivesMycophenolic acid (MPA) and tacrolimus (TAC) exhibit substantial pharmacokinetic variability, and volumetric absorptive microsampling (VAMS) offers a minimally invasive alternative for therapeutic drug monitoring (TDM). This study aimed to develop a VAMS-based method for MPA and TAC quantifications and systematically evaluate hematocrit (Hct)-adjusted conversion strategies.MethodsAdult transplant recipients receiving mycophenolate mofetil or mycophenolate sodium were prospectively enrolled. Paired plasma (MPA), whole-blood (TAC), and VAMS samples were analyzed using validated LC–MS/MS method for simultaneous MPA and TAC quantification. Multiple Hct-adjusted conversion approaches for MPA were compared using Passing-Bablok regression, Bland-Altman analysis, and predictive performance metrics. Clinical applicability was assessed through scenario-based AUC estimation MPA AUC estimations under different sampling schemes.ResultsLC-MS/MS method for quantifying MPA and TAC in VAMS exhibited good linearity (R2 > 0.99) and accuracy within 85–115% across validation ranges (10–20,000 ng/mL for MPA; 0.5–500 ng/mL for TAC). Formula A-ind [(VAMS/1 – individual Hct) x fbpp], where fbpp represents the MPA protein binding fraction (0.97), achieved clinical agreement in 86% of samples for the conversion of MPA concentrations between VAMS and plasma, representing the most balanced between predictive reliability and operational feasibility. TAC concentrations from VAMS correlated strongly with whole blood values without requiring Hct correction. Clinical case applications showed that rich eight-point VAMS sampling enabled more accurate AUC estimations than conventional three-point schemes, further highlighting the advantages of using VAMS for MPA TDM.ConclusionThis validated VAMS-based approach offers a minimally invasive and clinically applicable alternative to venous sampling for MPA and TAC monitoring. Incorporating individualized Hct adjustments improves predictive performance, supporting conditional integration of VAMS into routine TDM.
The integration of computational intelligence into therapeutic development is increasingly important for accelerating early-stage drug discovery and improving compound prioritization. In this study, we developed an optimized neural network-based predictive framework to support the identification of bioactive compounds with analgesic potential. A dataset of 532 structurally diverse molecules described by 227 molecular descriptors was analyzed, and a stepwise feature elimination procedure reduced the descriptor set to 105 informative variables, improving model robustness and reducing redundancy. The optimized artificial neural network, trained using the Levenberg-Marquardt algorithm, achieved a correlation coefficient of 95.9% with a prediction error of 0.433%, outperforming conventional statistical approaches reported for comparable QSAR tasks. Additional analysis links key descriptor groups, including connectivity and polarity parameters, to physicochemical properties relevant to analgesic activity, improving interpretability for medicinal chemistry applications. The framework is intended to support computational screening and candidate prioritization prior to experimental validation, thereby contributing to more efficient pharmacotherapeutic discovery workflows. This work highlights how data-driven modeling can complement translational strategies aimed at accelerating drug discovery pipelines.
Introduction:Professional satisfaction is a key determinant of career commitment and workforce sustainability and retention in the pharmacy sector. The study examines professional satisfaction among Romanian pharmacy graduates by analysing hygiene factors, intrinsic motivators, and perceptions of pay equity, assessing sector-based differences and exploring associations between these dimensions and long-term career commitment. Methods:A cross-sectional survey was conducted among 473 pharmacy graduates (2009-2023). Professional satisfaction was evaluated using 13 structured items from a questionnaire that covered hygiene factors, intrinsic motivators, and perceptions of pay equity. Reliability was assessed with Cronbach's α. Descriptive statistics, ANOVA, and chi-square tests were applied. Results:The Hygiene Index (α = 0.67; M = 3.28, SD = 0.76) and Motivators Index (α = 0.80; M = 3.22, SD = 0.86) reflected moderate satisfaction. The Pay-Equity Index showed very low scores (α = 0.77; M = 1.86, SD = 0.70). Salary satisfaction (M = 2.22, SD = 1.23) and expectations for future salary increases (M = 2.21, SD = 1.06) were rated as the lowest. Over 80% perceived their income as "much lower" than that of physicians or dentists. Only 7% stated they would "definitely" choose pharmacy again, while 46% responded "definitely not," and over 70% expressed some degree of non-recommitment. Community pharmacists consistently reported lower satisfaction across indices compared to peers in industry or education. Conclusion:Romanian pharmacists report moderate satisfaction with work conditions and collegiality, but widespread dissatisfaction with pay equity and career opportunities. Alarmingly, almost three-quarters of pharmacists said they would not choose pharmacy again, indicating a lack of professional commitment. The results raise substantial concerns about professional commitment and suggest a risk to the long-term sustainability of the Romanian pharmacy workforce. Urgent policy interventions are needed to address salary disparities, improve recognition, and expand career development pathways to retain qualified professionals and ensure the resilience of pharmaceutical services.
Asthma and allergies affect millions of people globally. Avoiding triggers and allergens is a basic management technique for all asthma subtypes (>80% of asthma patients also suffer from allergies), and pharmacological treatment is the cornerstone for acute exacerbations and ongoing maintenance. Typical treatment options for asthma include inhaled, oral, or injectable dosage forms. However, transdermal drug delivery has great potential to provide an alternative route of administration of necessary asthma and allergy therapies that have traditionally been given in other dosage forms. In Part 1 of this two-part series, we discussed the work done towards incorporating short- and long-acting β2-agonists into transdermal drug delivery systems. Here in part 2, we describe the current literature for transdermal applications of leukotriene antagonists, theophylline, and other adjunct medications that do not fall into one specific drug class. A brief overview of biologics, particularly monoclonal antibodies, and the role in asthma is also included, including some context of transdermal mAb delivery for disease states beyond asthma. Because of the relatedness of asthma and allergies, transdermal applications for allergen immunotherapy is also discussed.
Asthma and allergies are closely related conditions affecting millions of people around the world. Current treatment options cover many classes of drugs for both acute and ongoing conditions. β2-agonists, leukotriene modifiers, and corticosteroids represent some of the common types of drugs utilized in asthma management. These medications are often delivered via inhalation, oral, or parenteral methods, but each of these modalities faces challenges due to improper technique with inhalers, lessened oral bioavailability due to first-pass metabolism, and reduced compliance of injectable medicines. Transdermal drug delivery may offer a beneficial route of administration that overcomes these barriers as a painless, self-administered form that bypasses first-pass metabolism and can reduce dosing frequency with longer drug release profiles and reduced fluctuations in plasma drug levels. In this two-part mini-review series we will summarize the current literature on transdermal systems for asthma and allergy therapy. Here in Part 1, we cover β2-agonists and discuss the potential of transdermal systems for these drugs. While the body of work with transdermal β2-agonists for asthma treatment is limited, there is still evidence that transdermal systems for asthma has potential to greatly shift the field of asthma therapeutics.
