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This is followed by in‐process drying, which forms a critical step and may influence the physical properties of the incorporated excipients, drug, and overall quality of ODFs [Citation18].
| Step | Instruction | Precautions |
|---|---|---|
| Dose Placement | Place strip under tongue or inside cheek | Avoid swallowing immediately |
| Expect Dissolution | Wait until fully dissolved before eating/drinking | No water during dissolution |
| Timing Before Activity | Take 15-30 minutes before anticipated sexual activity | Avoid heavy meals near dosing |
| Storage | Keep strips in a cool, dry place, away from children | Keep away from moisture |
| Overdose Warning | Do not exceed prescribed dose | Seek medical attention if overdose suspected |
This method fabricates ODFs through a one‐step process without necessitating the preparation of API-loaded filaments, unlike other 3D printing technologies. The SSE is the utmost successful 3D printing method for fabricating ODFs. The optimum mixture of drug, excipients, and solvent defines the ideal rheological characteristics of the semi-solid formulation. This is extremely important as it affects the extrudability of semi-solid formulation in desired flow through the nozzle before printing.
- Sildenafil strips are an alternative to traditional pill forms.
- The strips dissolve quickly, eliminating need for water to swallow.
- They are convenient for on-the-go use and discreet consumption.
- Possible side effects include headache, flushing, and dizziness.
- Sildenafil strips should be used approximately one hour before activity.
- Not suitable for individuals with certain health conditions; consult a doctor.
- They are typically used in men aged 18 and above.
- The medication works by increasing blood flow to the penis.
- Sildenafil strips can be part of a broader erectile dysfunction treatment plan.
- Side effects may vary depending on individual health status.
- Erectile response may improve with proper use and dosing.
- They are available through licensed pharmacies and online sources.
Studies have shown that ODFs have exhibited fast disintegration time, appropriate printing resolution, and precise dimensions due to incorporation of 5% sodium carboxymethylcellulose during the preparation. Since this method avoids any processes at elevated temperatures, it allows usage of thermosensitive polymers for the fabrication of ODFs [Citation61,Citation71,Citation72]. The assessment and characterization of ODFs involve an array of essential tests to warrant their quality, organoleptic properties, and performance. These tests comprise assessments of thickness, weight uniformity, film robustness and durability, flexibility, water absorption or uptake capacity, swelling, surface features, and moisture content. The other tests involve disintegration and release tests, tensile properties, tensile strength, puncture resistance, elongation at break, elastic modulus, porosity, folding durability and endurance, taste evaluation, and uniformity of drug content. These tests are indispensable in pharmaceutical formulation development for evaluating the quality of ODFs.
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This is followed by in‐process drying, which forms a critical step and may influence the physical properties of the incorporated excipients, drug, and overall quality of ODFs [Citation18]. This method fabricates ODFs through a one‐step process without necessitating the preparation of API-loaded filaments, unlike other 3D printing technologies. The SSE is the utmost successful 3D printing method for fabricating ODFs. The optimum mixture of drug, excipients, and solvent defines the ideal rheological characteristics of the semi-solid formulation. This is extremely important as it affects the extrudability of semi-solid formulation in desired flow through the nozzle before printing.
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Studies have shown that ODFs have exhibited fast disintegration time, appropriate printing resolution, and precise dimensions due to incorporation of 5% sodium carboxymethylcellulose during the preparation. Since this method avoids any processes at elevated temperatures, it allows usage of thermosensitive polymers for the fabrication of ODFs [Citation61,Citation71,Citation72]. The assessment and characterization of ODFs involve an array of essential tests to warrant their quality, organoleptic properties, and performance. These tests comprise assessments of thickness, weight uniformity, film robustness and durability, flexibility, water absorption or uptake capacity, swelling, surface features, and moisture content. The other tests involve disintegration and release tests, tensile properties, tensile strength, puncture resistance, elongation at break, elastic modulus, porosity, folding durability and endurance, taste evaluation, and uniformity of drug content.
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These tests are indispensable in pharmaceutical formulation development for evaluating the quality of ODFs. A compilation of commonly used in vitro techniques that evaluate the mechanical characteristics is provided in Supplementary Table S1. Several studies have demonstrated bioequivalence between sildenafil ODF formulation and conventional film-coated tablets (FCTs). This display of bioequivalent pharmacokinetics between the two formulations supports and recommends the use of innovative ODF formulation as a befitting alternative to the customary oral solid dosage form [Citation73–75]. Two randomized cross-over studies were conducted to examine the pharmaceutical equivalence of 50 mg sildenafil citrate ODF with the marketed 50 mg sildenafil citrate FCT buy sildenafil online uk with and without water. A compilation of commonly used in vitro techniques that evaluate the mechanical characteristics is provided in Supplementary Table S1.
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Several studies have demonstrated bioequivalence between sildenafil ODF formulation and conventional film-coated tablets (FCTs). This display of bioequivalent pharmacokinetics between the two formulations supports and recommends the use of innovative ODF formulation as a befitting alternative to the customary oral solid dosage form [Citation73–75]. Two randomized cross-over studies were conducted to examine the pharmaceutical equivalence of 50 mg sildenafil citrate ODF with the marketed 50 mg sildenafil citrate FCT buy sildenafil online uk with and without water. The study recruited 42 and 80 healthy male volunteers in the first and second studies, respectively.
Author contributions
The study recruited 42 and 80 healthy male volunteers in the first and second studies, respectively. Bioequivalence was demonstrated for sildenafil citrate ODF with water in comparison with the sildenafil citrate FCT as the ratios of adjusted geometric means (90% confidence interval [CI]) were utmost plasma concentration: 1.02 [94.91–108.78] and area under the plasma concentration–time curve: 1.09 [104.49–113.21]) for sildenafil citrate ODF with water vs sildenafil citrate FCT with water. The bioequivalence was demonstrated as the resultant ratios were within the approved range of 80% to 125%. Furthermore, the pharmacokinetic parameters in the successive study also established the bioequivalence for sildenafil citrate ODF (without water) with that of sildenafil citrate FCT with water. The ratios of adjusted geometric means (90% CI) were maximum plasma concentration: 1.02 (95.47–109.36) and area under the plasma concentration–time curve: 1.06 (103.42–108.40) for sildenafil citrate ODF without water vs sildenafil citrate FCT with water.
4.2. Manufacturing of ODFs
The occurrence of adverse events was observed at similar rates for both the formulations in all the studies, which were of mild intensity. The study results demonstrated the bioequivalence and supported the interchangeability of new sildenafil citrate ODF formulation with the marketed FCT formulation [Citation76]. The usage of ODFs is convenient among patients due to its durability, ease of administration with no suffocation risk, and ease of carrying the strips without the need for a secondary container [Citation8]. Among other advantages, the sildenafil ODF offers unique benefit to patients with ED in respecting their privacy. While the shame and the stigma culturally linked to the ED management is considered a major unmet need of the patients treated with phosphodiesterase 5 inhibitors (PDE5-Is), the ODF allows them to carry the drug in their pockets, in the most discreet way, and then be placed on the tongue before engaging in sexual activity [Citation8,Citation77,Citation78].
Recreational use
Furthermore, the absence of the need to swallow the drug with water further increases the ease of use and the potential reduction of the stigma of being treated with a traditional pill. In fact, when the film is placed upon the tongue or in the oral cavity, it gets immediately hydrated by saliva without any need of water followed by rapid disintegration and drug release for oro-mucosal and/or systemic absorption [Citation76]. To further demonstrate the possibility to safely store the drug in the pocket, maximizing the need for a discreet treatment, a stress test has been conducted on sildenafil ODF by exposing it to elevated temperatures (60 degrees Celsius) for three weeks, mimicking extreme storage conditions and followed by evaluation of its physical and chemical stability. Ensuring the stability of pharmaceutical products is crucial to maintain their efficacy, safety, and quality throughout their shelf life, particularly critical in the case of sildenafil ODF. This test was conducted in Kyukyu Pharmaceutical Co., Ltd, Toyama Plant, Japan. Bioequivalence was demonstrated for sildenafil citrate ODF with water in comparison with the sildenafil citrate FCT as the ratios of adjusted geometric means (90% confidence interval [CI]) were utmost plasma concentration: 1.02 [94.91–108.78] and area under the plasma concentration–time curve: 1.09 [104.49–113.21]) for sildenafil citrate ODF with water vs sildenafil citrate FCT with water. The bioequivalence was demonstrated as the resultant ratios were within the approved range of 80% to 125%. Furthermore, the pharmacokinetic parameters in the successive study also established the bioequivalence for sildenafil citrate ODF (without water) with that of sildenafil citrate FCT with water.
- Sildenafil oral strips are a fast-acting form of erectile dysfunction medication.
- They are administered orally, dissolving quickly on the tongue for rapid effect.
- Sildenafil strips are often flavored to improve the user experience.
- They contain the same active ingredient as traditional sildenafil tablets.
- These strips are designed for people seeking discreet medication options.
- Onset of action for sildenafil strips can be within 15-30 minutes.
- Proper storage of sildenafil strips involves keeping them in a cool, dry place.
- Dosage strength varies, typically available in 25mg, 50mg, and 100mg.
- Using sildenafil strips without medical consultation is not recommended.
- They may interact with other medications like nitrates or alpha-blockers.
- Sildenafil oral strips are approved for the treatment of erectile dysfunction.
- Users should follow prescribed dosages for safety and effectiveness.
The ratios of adjusted geometric means (90% CI) were maximum plasma concentration: 1.02 (95.47–109.36) and area under the plasma concentration–time curve: 1.06 (103.42–108.40) for sildenafil citrate ODF without water vs sildenafil citrate FCT with water. The occurrence of adverse events was observed at similar rates for both the formulations in all the studies, which were of mild intensity. The study results demonstrated the bioequivalence and supported the interchangeability of new sildenafil citrate ODF formulation with the marketed FCT formulation [Citation76]. The usage of ODFs is convenient among patients due to its durability, ease of administration with no suffocation risk, and ease of carrying the strips without the need for a secondary container [Citation8]. Among other advantages, the sildenafil ODF offers unique benefit to patients with ED in respecting their privacy. While the shame and the stigma culturally linked to the ED management is considered a major unmet need of the patients treated with phosphodiesterase 5 inhibitors (PDE5-Is), the ODF allows them to carry the drug in their pockets, in the most discreet way, and then be placed on the tongue before engaging in sexual activity [Citation8,Citation77,Citation78]. Furthermore, the absence of the need to swallow the drug with water further increases the ease of use and the potential reduction of the stigma of being treated with a traditional pill.
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A thin pale red-colored ODF containing 50 mg sildenafil was formulated to dissolve in the oral cavity. Three batches of samples were subjected to a stability study at 60°C stress for three weeks. Subsequently, they were assessed for the amount of API assay (95.0%−105.0% of labeled amount), degradation, disintegration, dissolution rate (over 80% for 45 mm), and water content. All the test items of this stability study met the specifications and showed negligible differences between the samples. The amount of degradation products demonstrated an increasing trend over time in all conditions, but all met the required specification.
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The purity testing for the degradation product (0.2% or less) showed significant results (p value < 0.05) at initial and 60°C in all the three samples. The process was evaluated across a range of manufacturing conditions, and all intermediates and sildenafil ODF showed reliable performance that yielded a consistent product meeting all specifications at release and after three weeks of storage under stressed conditions. These results, shown in , indicate the robust performance of the sildenafil ODF across a range of manufacturing conditions. In addition, the water content stayed in a tight range regardless of the film casting parameters, and this remains true of the packaged product even after 3 weeks at 60°C. ED is defined as the persistent inability to attain and maintain an sildenafil citrate 100 mg erection sufficient to permit satisfactory sexual performance [Citation76,Citation79–81].
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ED still prevails as an unprecedented diagnosis and undertreated condition that contributes to increased physical and psychosocial burden. It negatively impacts the wellbeing, relationships, and health-related quality of life (HR-QoL) of patients and their partners [Citation82,Citation83], and thus, any treatment interventions that substantially revive sexual function have the prospect to reinforce patient health and overall HR-QoL. ED may present with clinically relevant forms but also subclinical conditions deserving medical attention. Worldwide, various forms of ED are diagnosed in up to 150 million men and it has been projected to surge to 322 million cases by 2025. ED has affected 52% of men in the age group of 40 and 70 years and 70% of men above 70 years [Citation84–87]. In fact, when the film is placed upon the tongue or in the oral cavity, it gets immediately hydrated by saliva without any need of water followed by rapid disintegration and drug release for oro-mucosal and/or systemic absorption [Citation76]. To further demonstrate the possibility to safely store the drug in the pocket, maximizing the need for a discreet treatment, a stress test has been conducted on sildenafil ODF by exposing it to elevated temperatures (60 degrees Celsius) for three weeks, mimicking extreme storage conditions and followed by evaluation of its physical and chemical stability. Ensuring the stability of pharmaceutical products is crucial to maintain their efficacy, safety, and quality throughout their shelf life, particularly critical in the case of sildenafil ODF. This test was conducted in Kyukyu Pharmaceutical Co., Ltd, Toyama Plant, Japan. A thin pale red-colored ODF containing 50 mg sildenafil was formulated to dissolve in the oral cavity. Three batches of samples were subjected to a stability study at 60°C stress for three weeks. Subsequently, they were assessed for the amount of API assay (95.0%−105.0% of labeled amount), degradation, disintegration, dissolution rate (over 80% for 45 mm), and water content.
- Sildenafil oral strips provide a non-invasive way to treat ED.
- They avoid swallowing pills, which some patients find difficult.
- Strips are often manufactured with pleasant flavors to enhance appeal.
- The medication’s effect can be influenced by food intake.
- Alcohol consumption may reduce effectiveness or increase side effects.
- Sildenafil strips should be used as prescribed and not mixed with other ED drugs.
- These strips are designed for quick absorption in the oral mucosa.
- Overuse or misuse can lead to adverse health effects.
- Proper dosing helps minimize risks of prolonged erections or priapism.
- Sildenafil strips do not cure ED but help manage symptoms.
- They may be used in combination with psychological or lifestyle interventions.
- Always check expiration dates before using sildenafil strips.
All the test items of this stability study met the specifications and showed negligible differences between the samples. The amount of degradation products demonstrated an increasing trend over time in all conditions, but all met the required specification. The purity testing for the degradation product (0.2% or less) showed significant results (p value < 0.05) at initial and 60°C in all the three samples. The process was evaluated across a range of manufacturing conditions, and all intermediates and sildenafil ODF showed reliable performance that yielded a consistent product meeting all specifications at release and after three weeks of storage under stressed conditions. These results, shown in , indicate the robust performance of the sildenafil ODF across a range of manufacturing conditions. In addition, the water content stayed in a tight range regardless of the film casting parameters, and this remains true of the packaged product even after 3 weeks at 60°C. ED is defined as the persistent inability to attain and maintain an sildenafil citrate 100 mg erection sufficient to permit satisfactory sexual performance [Citation76,Citation79–81]. ED still prevails as an unprecedented diagnosis and undertreated condition that contributes to increased physical and psychosocial burden. It negatively impacts the wellbeing, relationships, and health-related quality of life (HR-QoL) of patients and their partners [Citation82,Citation83], and thus, any treatment interventions that substantially revive sexual function have the prospect to reinforce patient health and overall HR-QoL. ED may present with clinically relevant forms but also subclinical conditions deserving medical attention. Worldwide, various forms of ED are diagnosed in up to 150 million men and it has been projected to surge to 322 million cases by 2025. ED has affected 52% of men in the age group of 40 and 70 years and 70% of men above 70 years [Citation84–87]. The primary risk factors include diabetes mellitus, hypertension, and hyperlipidemia and modifiable risk factors like obesity, physical inactivity, alcoholism, and cigarette smoking [Citation88–90]. In addition, there is increasing evidence that ED can be considered as the perfect gender-dependent (early) biomarker of non-communicable diseases (NCDs) including peripheral vascular disease and cardiovascular disease, with a heightened risk of cardiovascular mortality as largely demonstrated by epidemiological studies [Citation91]. Indeed, ED can be considered a symptom for underlying NCD that may be explained as the classical canary in the coalmine [Citation92].
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Inhibiting PDE5 produces a dilatation of the penile arteries that leads to a more prolonged and stable erection. Futhermore, PDE5-Is improve endothelial function and decrease apoptosis of smooth muscle cells in the corpus cavernosum [Citation93,Citation95]. The management of ED includes the identification and control of risk factors and appropriate pharmacological and non-pharmacological therapy. The treatment strategies undoubtedly can reduce the initial symptoms and halt the progression of the disease. Some of the treatment approaches encompass psychosexological strategies, intraurethral or intracavernosal alprostadil self-injections, vacuum-assisted erection devices, low-intensity extracorporeal shock wave treatment, and penile implants. Nevertheless, after the efforts to modify unhealthy lifestyle and control risk factors and comorbidities, pharmacological management with oral PDE5-Is stays as the first-line treatment choice for ED because of its proven efficacy and better safety profile [Citation8].
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The primary risk factors include diabetes mellitus, hypertension, and hyperlipidemia and modifiable risk factors like obesity, physical inactivity, alcoholism, and cigarette smoking [Citation88–90]. In addition, there is increasing evidence that ED can be considered as the perfect gender-dependent (early) biomarker of non-communicable diseases (NCDs) including peripheral vascular disease and cardiovascular disease, with a heightened risk of cardiovascular mortality as largely demonstrated by epidemiological studies [Citation91]. Indeed, ED can be considered a symptom for underlying NCD that may be explained as the classical canary in the coalmine [Citation92]. The management of ED includes the identification and control of risk factors and appropriate pharmacological and non-pharmacological therapy. The treatment strategies undoubtedly can reduce the initial symptoms and halt the progression of the disease.
7.5 Alcohol
Some of the treatment approaches encompass psychosexological strategies, intraurethral or intracavernosal alprostadil self-injections, vacuum-assisted erection devices, low-intensity extracorporeal shock wave treatment, and penile implants. Nevertheless, after the efforts to modify unhealthy lifestyle and control risk factors and comorbidities, pharmacological management with oral PDE5-Is stays as the first-line treatment choice for ED because of its proven efficacy and better safety profile [Citation8]. The PDE5-Is inhibit the PDE5 enzyme concentrated in the smooth muscle cells in the blood vessels [Citation93]. Due to this inhibition, PDE5-Is prevent the enzyme-initiated degradation of cyclic guanosine monophosphate (cGMP), which causes elevation of cGMP in the vascular smooth muscle. Elevated cGMP levels lead to dilatation of the blood vessels due to phosphorylation of various downstream effector molecules, ensuring relaxation of smooth muscles [Citation94]. The PDE5-Is inhibit the PDE5 enzyme concentrated in the smooth muscle cells in the blood vessels [Citation93]. Due to this inhibition, PDE5-Is prevent the enzyme-initiated degradation of cyclic guanosine monophosphate (cGMP), which causes elevation of cGMP in the vascular smooth muscle. Elevated cGMP levels lead to dilatation of the blood vessels due to phosphorylation of various downstream effector molecules, ensuring relaxation of smooth muscles [Citation94]. Inhibiting PDE5 produces a dilatation of the penile arteries that leads to a more prolonged and stable erection. Futhermore, PDE5-Is improve endothelial function and decrease apoptosis of smooth muscle cells in the corpus cavernosum [Citation93,Citation95].
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