Mais la polymyxine n'est pas du tout absorbée dans le sang du système gastro-intestinal et n'a d'effet que dans l'intestin et est utile pour le traitement des infections intestinales doxycycline prix Internet en y faisant des achats permettant d’économiser jusqu'à soixante-dix pour cent, tout en étant sûr de la qualité des produits pharmaceutiques.
Oral disintegrating tablets: an overview
Review Article www.ijcps.com International Journal of Chemical and Pharmaceutical Sciences 2010, Dec., Vol.1 (2) Oral Disintegrating Tablets: An Overview *Velmurugan S and Sundar Vinushitha KLR Pharmacy College, Palvoncha, Khammam, Andhra Pradesh, India. *corresponding author: E-mail- [email protected] ABSTRACT
Oral drug delivery remains the most preferred route for administration of various
therapeutic agents. Recent advances in technology prompted researchers and scientists to develop oral disintegrating tablets (ODTs) with improved patient convenience and compliance. ODTs are solid unit dosage form which dissolve or disintegrate rapidly in the mouth without water or chewing. Novel ODT technologies address many patient and pharmaceutical needs such as enhanced life cycle management to convenient dosing particularly for pediatric, geriatric and psychiatric patients who have difficulty in swallowing (Dysphagia) conventional tablet and capsules. Technologies used for manufacturing of ODTs are either conventional technologies or patented technologies. This review depicts the various aspects of ODT formulation, superdisintegrants and technologies developed for ODT, along with various drugs explored, evaluation tests and marketed formulations in this field.
Keywords: Disintegration, Oral disintegrating tablets, Superdisintegrant. 1. Introduction
Dysphagia[3] (difficulty in swallowing) is
considered as the most widely accepted route
because of its convenience of self specific with pediatric, geriatric population administration, compactness and easy along with institutionalized patients ,psychiatric manufacturing.[1-2] But the most evident
patients and patients with nausea, vomiting, and
drawback of the commonly used oral dosage
motion sickness complications.[1] ODTs with
forms like tablets and capsules is difficulty in
good taste and flavor increase the acceptability
swallowing, leading to patients incompliance
of bitter drugs by various groups of population.
particularly in case of pediatric and geriatric
patients[1], but it also applies to people who
advantages of dry and liquid formulation. Some
are ill in bed and to those active working
novel ODT technology allow high drug loading,
patients who are busy or traveling, especially
have an acceptable taste, offer a pleasant mouth
felling, leaving minimal residue in the mouth
development of orally disintegrating tablets
investigated for their potential in improving
(ODTs) has enormously increased as it has
bioavaibility of poorly soluble drug through
significant impact on the patient compliance.
enhancing the dissolution profile of the drug
Orally disintegrating tablets are appreciated
particularly who have difficulty in called as orodispersible tablets, quick
Review Article www.ijcps.com
disintegrating tablets, mouth dissolving
tablets, fast disintegrating tablets, fast
institutionalized patient ( specially for
dissolving tablets, rapid dissolving tablets,
mentally retarded and psychiatric patients)
porous tablets, and rapimelts. However, of all
· Pregastric absorption leading to increased
bioavaibility/ rapid absorption of drugs from
pharmacopoeia (USP) approved these dosage
passes down to stomach, also avoids hepatic
orodispersible tablet for tablets that disperses readily and within 3 min in mouth before
· Convenient for administration to traveling
swallowing.[4] Some of super disintegrants
patients and busy people who do not have
employed in ODTs are discussed in Table 1.
United States Food and Drug · Excellent mouths feel property produced by
Administration (FDA) defined ODT as “A
use of flavours and sweetners help to change
the perception of “medication as bitter pill”
disintegrates rapidly usually within a matter
· Fast disintegration of tablets leads to quick
of seconds when placed upon the tongue.”
dissolution and rapid absorption which may
The disintegration time for ODTs generally
ranges from several seconds to about a minute. [5]
· ODTs offer all the advantages of solid
2. Drug selection criteria
· Convenience of administration and accurate
4. Desired criteria for ODTs [8-10]
ODT should leave minimal or no residue in
At least partially non-ionized at the oral
mouth after oral administration, compatible
· Have the ability to diffuse and partition
· Effective taste masking technologies should
· Exhibit low sensitivity to environment
· Low dose drugs preferably less than 50
condition such as humidity and temperature.
· ODTs should dissolve / disintegrate in the
· Short half life and frequent dosing drugs
mouth in matter of seconds without water.
· Have sufficient mechanical strength and
· Drug should have good stability in saliva
· The drug and excipients property should not
· Very bitter or unacceptable taste and
affect the orally disintegrating tablets.
· Be portable and without fragility concern.
3. Advantages [7,8] 5. Technologies used for manufacturing of
· Easy to administer to the patient who
orally disintegrating tablets Review Article www.ijcps.com
formulating ODTs including conventional technologies and patented technologies.
Table 4 enlisted the various drugs explored
5.1. Conventional Technologies 5.1.1. Freeze drying or lyoplilization
A process, in which water is thereby enhancing the dissolution characteristic
sublimated from the product after freezing, is
of the formulation. The entire freeze drying
called freeze drying. Freeze- dried forms
process is done at nonelevated temperature to
eliminate adverse thermal effects that may
available solid products. The lyophilization
affect drug stability. The major disadvantages of
processes imparts glossy amorphous lyophilization technique are that it is expensive structure to the bulking agent and some times
conventional packaging unsuitable for these
Table 1: Superdisintegrants employed in
products and poor stability under stressed
conditions and their limited ability to accommodate adequate concentration of
Mechanism disintegrants of Action 5.1.2. Direct compression
direct compression. Low manufacturing cost,
conventional equipments and limited number of
processing steps led this technique to be a
preferable one. However disintegration and
dissolution of directly compressed tablets
disintegrant, water soluble excipients and
effervescing agents. It is essential to choose a
suitable and an optimum concentration of
disintegrant to ensure quick disintegration and dissolution. Superdisintegrants are newer
substances which are more effective at lower
concentrations with greater disintegrating
efficiency and mechanical strength. On contact
with water the superdisintegrants swell, hydrate,
disruptive change in the tablet. Effective
compressibility, compatibility and have no
negative impact on the mechanical strength of
formulations containing high dose drugs. The
type of disintegrants and its proportion are of
prime importance. Also factors to be considered
Review Article www.ijcps.com
are particle size distribution, contact angle,
can be added to the formulation, but then the
pore size distribution and water absorption
rate of tablet solubility usually decreases.[16,17]
capacity. Studies revealed that the water
5.1.4. Mass extrusion
insoluble superdisintegrants like sodium starch glycolate and Croscarmellose sodium
show better disintegration property than the
active blend using the solvent mixture of water
slightly water soluble agents like soluble polyethylene glycol, using methanol and Crospovidone, since they do not have a
expulsion of softened mass through the extruder
tendency to swell. Superdisintegrants that
or syringe to get a cylinder shaped extrude
tend to swell show slight retardation of the
which are finally cut into even segments using
disintegration property due to formation of
heated blade to form tablets. This process can
viscous barrier. There is no particular upper
also be used to coat granules of bitter drugs to
limit regarding the amount of mask their taste. Mass extrusion was the superdisintegrant as long as the mechanical
technique used for preparing taste masked
properties of the tablet are compatible with
granules. The tablet was prepared with different
its intended use. The superdisintegrant may
super disintegrate e.g. sodium starch glycolate,
be used alone or in combination with other
5.1.3. Molding 5.1.5. Melt granulation
from soluble ingredients, by compressing a
powder mixture which is moistened with a
efficiently agglomerated by a melt able binder.
solvent, into mould plates to form a wetted
The advantage of this technique compared to a
conventional granulation is that no water or
prepared directly from a molten matrix, in
organic solvents is needed. For accomplishing
which the drug is dissolved or dispersed or
this process, high shear mixers are utilized,
where the product temperature is raised above
solution or suspension at a standard pressure.
the melting point of binder by a heating jacket
Usually molded tablets are compressed at a
or by the heat of friction generated by impeller
lower pressure than are conventional are
blades. This approach to prepare FDT with
conventional tablets, and posses a porous
sufficient mechanical integrity, involves the use
structure that hastens dissolution. To of a hydrophilic waxy binder (Superpolystate, improve the dissolution rate, the powder
PEG-6-stearate). Superpolystate is a waxy
blend usually has to be passed through a very
material with a melting point of 33–37°C and a
fine screen. Tablet produced by molding are
HLB value of 9. So it will not only act as a
solid dispersion. Molded tablets disintegrate
binder and increase the physical resistance of
tablets but will also help the disintegration of
because the dispersion matrix is in general
the tablets as it melts in the mouth and
made from water soluble sugars. The active
solublises rapidly leaving no residues.[20]
5.1.6. Phase transistion process
through the mucosal lining of the mouth.
Kuno et al proposed a novel method to
Unfortunately, moulded tablets typically do
prepare ODTs with sufficient hardness by
involving the phase transition of sugar alcohol.
Erosion and breakage of the moulded tablets
often occurs during tablet handling and when
compressing powder containing erythritol
blister pockets are opened. Hardness agents
Review Article www.ijcps.com
(melting point: 122 °C) and xylitol (melting
mouth the freeze dried structure disintegrates
point: 93 - 95 °C), and then heating at about
instantaneously and does not require water for
93 °C for 15 min. After heating, the median
swallowing. Polymers such as gelatin, dextran
pore size of the tablets was increased and
or are incorporated to impart strength during
tablet hardness was also increased. Heating
handling. Mannitol or sorbitols are incorporated,
to obtain crystallanity, elegance and hardness.
particles leading to sufficient hardness of
Flocculating agents (e.g, xanthan gum and
tablets which was otherwise lacking owing to
acacia) to provide uniform dispersion of drug
particles; preservatives(e.g., parabens) to
5.1.7. Sublimation
prevent microbial growth; permeation enhancers(e.g., sodium lauryl sulphate) to
The slow dissolution of the improve transmucosal permeability; pH
compressed tablet containing even highly
adjusters(e.g, citric acid) to optimize chemical
water soluble ingredients is due to the fact
stability; flavours and sweetners to improve
that the low porosity of the tablets reduces
manufacturing process to ensure production of
the matrix. When inert volatile solid ingredie
porous units to achieve rapid disintegration.
Gums prevent the sedimentation of dispersed
carbonate, benzoic acid, camphor, hexameth
particles in manufacturing process. Collapse
ylene tetramine, naphthalene, phthalic protectants like gelatin prevents the shrinkage of
anhydride, urea and urethane were added to
Zydis units during freeze-drying process or on
along with other tablet excipients and the
long term storage. The product is very light
blend was compressed in to a table, which
weight and fragile, and must be dispensed in a
sublimation resulting in highly porous structures. Sublimation has been used to
5.2.2. Orasolv technology
compressed tablets exhibit good mechanical
dissolving/disintegrating dosage form. In this
strength and have high porosity system active medicament is taste masked, (approximately 30%) rapidly dissolved
contains disintegrating agent. The disintegration
of ODT in the mouth is cause by the action of
5.2. PATENTED TECHNOLOGIES
an effervescent agent, activated by saliva. The amount of effervescent agent is in general about
5.2.1. Zydis technology
20-25% of the total weight of the tablet. The
Zydis was the first marketed widely used effervescent disintegration pair
technology developed by R.P.Scherer,Inc.
usually include an acid source (citric, tartaric,
malic, fumeric, adipic and succinics ) and a
tablets .Zydis, the best known of the fast
carbonate source (sodium bicarbonate, sodium
dissolving/disintegrating tablet preparations
carbonate, potassium bicarbonate and potassium
was the first marketed new technology tablet.
The tablet dissolves in the mouth within
seconds after placement on the tongue.Zydis
maintain the integrity of the coating.The major
formulation is a unique freeze dried tablet in
disadvantage of the OraSolv formulations is its
mechanical strength. For that reason, Cima
developed a special handling and packaging
components, a saccharide e.g. mannitol and a
system for OraSolv. Manufacturing requires a
polymer. When Zydis units are kept in the
controlled environment at low relative humidity
Review Article www.ijcps.com
and protection of the final tablets with
5.2.5. Cotton candy technology
This process is so named as it utilizes an
5.2.3. Durasolv technology
inimitable spinning mechanism to produce floss
Durasolv is CIMA’s second like crystalline structure, which mimics cotton
generation fast dissolving or disintegrating
candy. The cotton candy process also known as
tablet formulation to produce stronger tablets
the candy floss process. A mouth dissolving
tablet is formed using candy floss or shear form
bottles. Durasolv has much higher matrix.It involves the formation of matrix of mechanical strength due to use of the higher
polysaccharides or saccharides by simultaneous
compaction pressure during tabletting. One
action of flash melting and spinning. The matrix
formed is partially recrystallised to have
technology is not compatible with larger
improved flow properties and compressability.
doses of active ingredients, because the
This candy floss matrix is then milled and
formulation is subjected to high pressure
blended with active ingredients, excipients and
during compaction. The drug powder coating
subsequently compressed to ODT. This process
can accommodate larger drug doses and offer
compaction, exposing the bitter tasting drugs
improved mechanical strength. However, high
to the patient taste buds.So This technology
process temperature limits the use of this
is good for tablets having low amount of
5.2.6. Oraquick technology 5.2.4. Wow tab technology
The WOW in the WOWTAB disintegrating tablets formulation utilizes a
signifies the tablet is to be given without
patented taste masking technology. This taste
water. This technology utilizes sugar and
masking process does not utilize solvents of any
sugar-like excipients. The two different types
kind, so leads to faster and more efficient
production. During processing low-heat is
tablet formulation with adequate hardness
produced so this technique is suitable for heat
and fast dissolution rate. The two different
sensitive drugs. KV pharmaceuticals also claims
saccharides are those with high moldability
that the matrix that surrounds and protects the
like maltose, mannitol, sorbitol, and drug powder in microencapsulated particle is oligosaccharides.(good binding property) and
more pliable.This technique gives tablets with
good taste masking and quick dissolution in
mannitol, xylitol (rapid dissolution). Tablets
5.2.7. Nanocrystal technology
sufficient hardness to maintain the physical
characteristics of the dosage form during
technology provides for: Pharmacokinetic
production until it comes in contact with
benefits of orally administered nanoparticles
moisture such as saliva in mouth. Due to the
(<2 microns) in the form of a rapidly
significant hardness the WOWTAB disintegrating tablet matrix.Nano Crystal
formulation is more stable to the colloidal dispersions of drug substance are
combined with water-soluble GRAS (Generally
Erythritol was found to be the best sugar for
Regarded As Safe) ingredients, filled into
blisters, and lyophilized. This method avoids
disintegration which is unaffected by tablet
manufacturing process such as granulation,
Review Article www.ijcps.com
advantages for highly potent and hazardous
a standard tablet press with stock tooling. The
drugs.For fast dissolving tablets, Elans
manufacture process can be carried out under
normal temperature and humidity conditions.
The tablets can be packaged in blister packs or
activity and final product characteristics.
Decreasing particle size increases the surface
5.2.10. Frosta technology
area,which leads to an increase dissolution rate. [27]
concept of Frosta technology is compressing
5.2.8. Shearform technology
highly plastic granules at low pressure to
produce strong tablets with high porosity. The
matrix, ‘Floss’ is prepared. Feedstock
highly plastic granules comprise three classes of
prepared with a sugar carrier is subjected to
components: a porous and plastic material, a
flash heat processing. In this process, sugar is
water penetration enhancer, and a binder. The
simultaneously subjected to centrifugal force
process involves mixing the porous plastic
and to a temperature gradient, which causes
material with water penetration enhancer
the temperature of the mass to rise and hence
followed by granulating with binder. The
technology can be used for almost any drugs
permitting part of it to move with respect of
including aspirin, loratidine, caffeine, and folic
the mass. This is followed by its exit through
acid, vitamins and dietary supplements. The
the spinning head that flings the floss under
highly plastic granule approach produces fast
centrifugal force and draws into long and
melting pharmaceutical tablets with excellent
thin floss fibres, which are usually hardness and fast disintegration time ranging amorphous in nature.the floss so produced is
from several seconds to 30 seconds, depending
further chopped and recrystallised to provide
a uniform flow, thus facilitate blending. Then
6. EVALUATION OF ODTs
the recrystallised matrix, active drug and other excipients are blended together and
finally compressed into tablets. Active drug
mentioned in the Pharmacopoeias need to be
and other excipients may be blended with the
assessed, along with some special tests are
floss before recrystallising it. The tablets
6.1. Hardness
porous in nature and offer very pleasant
A significant strength of ODT is difficult
mouth feel due to rapid solubilisation of
to achieve due to the specialized processes and
ingredients used in the manufacturing. The limit
5.2.9. Pharmaburst technology
of hardness for the ODT is usually kept in a
lower range to facilitate early disintegration in
by SPI pharma. Pharmaburst technology uses
the mouth. The hardness of the tablet may be
off the shelf coprocessed excipients to create
measured using conventional hardness test.
an ODT that, depending on the type of active
6.2. Friability
ingredients and loading, dissolves within 30-
To achieve % friability within limits for
an ODT is a challenge for a formulator since all
required in a formulation depends on the
active ingredients in the tablet. The process
responsible for increasing the % friability values.
involves a dry blend of a drug, flavor and
Thus, it is necessary that this parameter should
lubricant that are compressed into a tablet on
Review Article www.ijcps.com
be evaluated and the results are within bound
implies a quicker disintegration of the tablet.
The wetting time of the tablets can be measured
Table .2 ODT products available in
by using the simple procedure.[29] Five circular
international market
tissue papers of 10cm diameter are placed in a petridish. Ten milliliters of water soluble dye
solution is added to petridish. A tablet is carefully placed on the surface of the tissue
paper. The time required for water to reach
upper surface of the tablet is noted as the
For measuring water absorption ratio the
weight of the tablet before keeping in the
petridish is noted (Wb). The wetted tablet from
the petridish is taken and reweighed (Wa). The
water absorption ratio, R can be the determined
6.4. Moisture uptake studies
be conducted to assess the stability of the
formulation. Ten tablets from each formulation
were kept in a dessicator over calcium chloride
at 370C for 24h. The tablets were then weighed
and exposed to 75% relative humidity, at room
temperature for 2 weeks. Required humidity
was achieved by keeping saturated sodium
chloride solution at the bottom of the dessicator
for 3 days. One tablet as control (without super
disintegrants) was kept to assess the moisture
uptake due to other excipients. Tablets were weighed and the percentage increase in weight
6.5. Disintegration test
generally <1min and actual the disintegration
time that patients can experience ranges from 5
6.3. Wetting time and water absorption
to 30s. The standard procedure of performing
disintegration test for these dosage forms has several limitations and they do not suffice the
measurement of very short disintegration times.
related to with the contact angle. Wetting
The disintegration test for ODT should mimic
disintegration in mouth with in salivary contents.
parameter, which needs to be assessed to give an insight into the disintegration
properties of the tablet. Lower wetting time
Review Article www.ijcps.com 6.6. Dissolution test
methods for ODT is comparable to approach
utilize taste masking. Commonly the drugs
may have dissolution conditions as in USP
monograph. Other media such as 0.1 N HCl,
pH 4.5 and pH 6.8 buffers should be used for
evaluation of ODT in the same way as their
ordinary tablet counterparts. Experience has
trapped on the inside top of the basket at the
indicated that USP 2 paddle apparatus is
spindle where little or no effective stirring
occurs, yielding irreproducible results in
dissolution test of ODT tablets, where a
paddle speed of 50 rpm is commonly used.
Table .4: Drugs explored for orally
Typically the dissolution of ODTs is very
disintegrating tablet [31]
fast when using USP monograph conditions. Hence slower paddle speeds may be utilized
Category Drugs Category Drugs
to obtain a comparative profile. Large tablets
Analgesics and Anti- Epileptics inflammat
containing relatively dense particles may
ory Agents
produce a mound in the dissolution vessel,
paddle speeds. These two situations expand
the suitable range of stirring to 25-75 rpm.
certain applications for ODT but is used less
frequently due to specific physical properties
Table 3: ODT products in Indian market: bacterial Hypertensi ve Agents: Brand Name Ingredients Arrhythm Neoplastic ic Agents Immunosu ppressants Review Article www.ijcps.com bacterial Inotropic Blockers : Protozoal Malarials: coagulants Diuretics: 7. Patient counseling points for ODT Anxiolytic, Sedatives, Parkinsoni Hypnotics an Agents:
advancement in novel dosage form, thus have
Neurolepti
opportunity to counsel the patient for effective
treatment. Educating the patients about ODT
Anti-Gout
can avoid any confusion and misunderstanding
Counseling points to the patients include:
Histamine Regulatin g Agents: Receptor Antagonist
effervescent tablets, pharmacist need to
be clearly told about the different between
durasolv use slight effervescence, patients
may experience a pleasant tingling effect
Nitrates And Other Migraine
· Patients with dryness of mouth or with
Corticoster analgesics
efficiently but most technologies of ODT
Intestinal Muscarinic Review Article www.ijcps.com
clinical findings. Medical clinics of North America., 1993; 77: 3-5.
4. Fu Y, Yang S, Jeong SH, Kimura S, Park K.
Developments, technologies, taste-masking
and clinical studies. Critical Review in Therapeutic Drug Carrier System. 2004;
· With the pharmacist counseling, 5. Brown D. Orally Disintegrating Tablets-
intervention and assistance all of these
Taste over Speed. Drug Delivery Technology. 2003; 3:58-61. 8. CONCLUSION
Target Release Profile, pharmainfo.net
7. Makino T, Yamada M. and Kikuta, J. Fast
dissolving tablet and its production, 1993,
compliance, convenience, bioavailability and
European Patent. 0553777 A2.
rapid onset of action. They are a very good
8. Reddy L. H, Ghosh B, and Rajneesh. Fast
alternative for drug delivery to geriatric and
dissolving drug delivery systems: a review
pediatric patients. They have significant
of the literature. Indian Journal of
advantages of both solid and liquid dosage
Pharmaceutical Science. 2002; 64(4): 331-
forms, as they remain solid during storage,
which aid in stability of dosage forms and transform into liquid form within few
9. Seager H. Drug-deliver products and the
seconds after its administration. As a result
zydis fast-dissolving dosage form. Journal of Pharmacy and Pharmacology. 1998;
formulation, several commercial products are
system for most of the drugs in near future.
(kneading) technique. AAPS Pharm. Sci. 9. REFERENCES Tech., 2006; 7(3): 68-75
1. Sastry SV, Nyshdham JR, Fix JA. Recent
11. Reig AR, Plazas F, Galvan CJ, Heras NJ,
delivery: A review. Pharmaceutical Science and Technology Today. 2000;
patients. Satisfaction and expectancies. Allergol. Immunopathology. (Madr.,). 2006;
2. Seager H. Drug-delivery products and the
Zydis fast-dissolving dosage form. Journal of Pharmacy and 12. Ahmed IS, Nafadi MM and Fatahalla FA, Pharmacology. 1998; 50(4):375-82.
Formulation of a fast-dissolving ketoprofen tablet using freeze-drying in blisters
Review Article www.ijcps.com
technique. Drug Development and
method of preparing highporosity rapidly
Industrial Pharmacy. 2006; 32(4): 437-
13. Cirri M, Valleri M, Mura P, Maestrelli F
Internatinal Journal of Pharmaceutics, 1997; 152: 127-31.
Superdisintegrants for Solid Dispersion To
Development and Industrial Pharmacy.
Produce Rapidly Disintegrating Tenoxicam
Pharmaceutical Technology. 2005; 2: 68.
24. Allen LV, Wang B and Davis JD. US
composition. US Patent. 2005; 6: 899. patent. 1998; 5: 807 & 567.
25. Acosta C, Tabare R and Ouali A. US patent.
SH, Pharma Times. 2003; 35: 7.
16. Dobetti L. Fast Melting Tablets: 26. Seager H. Drug-delivery products and the
Zydis fast-dissolving dosage. Journal of Pharmaceutical Technology. 2001; 44- Pharmacy and Pharmacology. 1998; 50:
27. Kaushik D, Dureja H and Saini TR. Orally
disintegrating tablets: An overview of melt-
method of producing the same. US
in mouth tablet technologies and techniques,
patent. 5, 082, 667.
18. Makino T, Yamada M and Kikuta J. US
28. Fu Y, Yang S, Jeong SH, Kimura S and
patent. 1998; 5: 20 & 974.
Park K, Orally fast disintegrating tablets:
19. Gohel M, Patel M, Agarwal R and Dev R.
Developments, technologies, taste-masking
and clinical studies, Critical Review in
Therapeutic Drug Carrier System. 2004; AAPS Pharm Sci Tech. 3, 2004, 36.
29. Gohel M, Patel M, Amin A, Agarwal R,
and optimization of mouth dissolving tablets
The preparation of orally disintegrating
tablets using a hydrophilic waxy binder,
technique. AAPS Pharm Sci Tech., 2004; Internatinal Journal of Pharmaceutics.
30. Panigrahi D, Baghel S and Mishra B, Mouth
Patented technologies. J Pharm Research. Journal of Control Release. 2005; 105:
31. Shailesh Sharma. New generation of tablet:
Fast dissolving tablet. Pharmainfo.net.
FACT SHEET Neck Adjustment: Benefits and Safety The mandate of the Chiropractors’ Association of Australia (CAA) and its members1 is to make the care of patients their first concern, to practise safely and effectively, and to maintain a high level of professional competence and conduct that is essential for good care. Part of the core values of the Chiropractors’ Association of
FILE: Trauma Handbook/ stress ulcer prophylaxis UCSD MEDICAL CENTER ADULT AND PEDIATRIC GUIDELINES FOR USE OF STRESS ULCER PROPHYLAXIS* *Developed by the Stress Ulcer Prophylaxis Process Action Team Based on clinical studies, the indications for stress ulcer prophylaxis will be graded according to the following scale: Convincing evidence, indicated Some evidence, probably ind