Fixed-Dose Combinations for HIV/AIDS, Tuberculosis, and Malaria - Report of a Meeting Held 16-18 December 2003 Geneva
(2003; 199 pages) View the PDF document
Table of Contents
Open this folder and view contentsSummary: Observations and some ways forward
Open this folder and view contentsWelcome
Open this folder and view contentsFixed-dose combinations for tuberculosis: lessons learned from a clinical, formulation and regulatory perspective
Open this folder and view contentsProduct costs of fixed-dose combination tablets in comparison with separate dispensing and or co-blistering of antituberculosis drugs
Open this folder and view contentsFixed-dose combinations: artemisinin-based combination therapies for malaria treatment
Open this folder and view contentsDeveloping combinations of drugs for malaria examination of critical issues and lessons learnt
Open this folder and view contentsSafety and long-term effectiveness of generic fixed-dose formulations of nevirapine-based HAART amongst antiretroviral-naïve HIV-infected patients in India
Open this folder and view contentsEffect of introduction of fixed-dose combinations on the drug supply chain: experiences from the field
Open this folder and view contentsEffect of fixed-dose combination (FDC) medications on adherence and treatment outcomes
Open this folder and view contentsEffect of fixed-dose combination (FDC) drugs on development of clinical antimicrobial resistance: a review paper
Open this folder and view contentsFixed-dose combination (FDC) drugs availability and use as a global public health necessity: intellectual property and other legal issues
Close this folderPharmaceutical development and quality assurance of FDCs
View the documentAbstract
View the documentIntroduction
View the documentPreformulation studies
View the documentSome examples of the relevance of the properties of the API to product formulation!
View the documentGood Manufacturing Practice (GMP)
View the documentIssues that may arise in the formulation of FDCs that do not arise for single entity products include:
View the documentChanges to registered products (variations)
View the documentQuality control of FDCs
View the documentRecommendations
View the documentReferences
View the documentAnnotated agenda
View the documentList of participants
 

Changes to registered products (variations)

Ongoing monitoring of product quality is essential. A product does not stand still; it changes over time. Not just in its stability, but in the materials and processes that contribute to manufacture. Perhaps the manufacturing equipment is replaced with something more modern? Or one of the ingredients is no longer available from the same supplier. Or the old pack size is no longer economically viable and marketing wants a pack that holds twice the quantity. Or storage conditions in the field are more extreme than was envisaged. Or the manufacturer wishes to extend the shelf life that was approved at first registration. The sponsor must ensure that there is no change to quality, safety or efficacy, including bioavailability. The key word here is validation. It must be demonstrated that changes/variations do not lead to a reduction in quality, either at batch release or on storage. Guidelines exist as to how to validate such changes35, 36, 37.

In addition, random postmarket testing by regulatory authorities is intended to (as we say in Australia) keep the bastards honest. Targetted sampling is more efficient when a history is available for the type of product or for the manufacturer.

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Last updated: May 3, 2013