Medicated straw: an innovative drug delivery system for paediatrics

Improving patient compliance and acceptability has always inspired formulators to innovate novel drug delivery systems. Conventional and innovative pediatric dosage forms have been developed over the last two decades that consider factors such as medication preferences, compliance, acceptability, and therapeutic outcomes. Ideally, pediatric dosage forms must be safe, palatable, and possess an accurate dose with minimal medication errors. The Europe Pediatric Translational Research Infrastructure (EPTRI) is a funded project that strengthens collaboration in the scientific pediatric community throughout Europe to cover the gaps in pediatric medical research. Additionally, EPTRI aims to support driven innovative research in pediatric drug discovery and pharmaceutical product development [1].

Swallowing tablets and/or capsules may be problematic and is a major causes of poor patient compliance, especially for children and elderly patients. Additionally, patients who are bedridden or struggling with paralysis and are unable to take conventional dosage forms need an alternative option for drug administration. The medicated straw is an innovative delivery system that enables drug intake with nonviscous liquids such as water, tea, juice, or any other beverage. The basic design of a medicated straw is structured as a long hollow tube with openings at both ends. One end has to dip in a liquid, while the liquid is sipped from the other end. The drug may be filled inside the hollow tube in the form of powder or pellets/granules. It is a simple yet effective method for accurate drug administration to pediatric and geriatric patients [2,3].

Taste-masked polymer-coated crystals of paracetamol were loaded into a straw for children and patients with swallowing difficulties [4]. Medicated straws could be loaded with vitamins, minerals, antibiotics, probiotics, and taste-masked medicines for oral administration to enhance patient compliance and potential therapeutic benefits. β-galactosidase enzyme-containing particulates were loaded in polypropylene-based drinking straws. Fluid intake speed and fluid temperature significantly affect the rate of drug release from the medicated straw [5]. Another study developed carvedilol solid dispersion-based electrospun fibers which were loaded into plastic straws. The solid dispersion of carvedilol revealed an ultrafast drug release rate in liquid administration through the straw, as well as enhanced stability, drug dissolution, and better compliance [6]. Generally, active pharmaceutical ingredients are bitter, and sweeteners, flavoring agents, or polymer coatings are employed for enhancing drug palatability.

The United States patent number US 5718681A is a medicine delivery system that delivers drugs held within a straw tube. The straw has a particle barrier at one end that prevents the falling out of powdered medicines from the straw. Additionally, the particle barrier allows simultaneous entry of fluid due to the presence of apertures. Moreover, the straw has a medicine sac whose walls allow fluid to pass to dissolve the medication. The patent covers all achievable ways of drug storage in the straw with some additional features, such as a straw with a funnel for filling drug particles, a medication sack, attaching pill crushers, and removable caps [7]. However, physicochemical properties, drug stability, economic factors, large-scale production, commercialization, and drug release are some of the challenges to be monitored and adequately addressed for exploring the common use of medicated straws.

The United States patent number US8334003B2 explains the development of medicated straw loaded with pellets containing a predetermined dose of the active ingredient and flavoring agent. Pellets are filled within the elongated tube and a receptacle is placed at both ends of the tube to retain the pellets within the system. The perforations in the receptacle act as a sieve to retain the pellets and only allow the liquid to flow through them. The passage of carrier liquid through the receptacle leads to pellet dissolution resulting in the release of the active ingredient. The patent focuses on the specifications of the receptacle used in the straw [8]. However, the patent does not disclose the quality control testing required for medicated straws to ensure reproducibility and sustainability for better patient compliance and therapeutics.

A functional straw having structural modification has been described in patent number CN210384428U. The modified straw comprises three parts, including the upper and lower parts, which have a straw-like structure with foldable features, and the middle part consists of a paddle that rotates with the flow of fluid and increases embedded drug dissolution and disintegration. The suction pipe of the straw possesses a check valve for a one-directional flow of the liquid. The foldable region of the straw is specially designed for bedridden patients so they can adjust the straw at their convenience [9]. The technical complexity of the design and insufficient quality control evaluation tests limits the commercial acceptability of the developed medicated straw.

Some companies have attempted to commercialize the medicated straws targeting a different purpose. A sipping device Clarosip^Ⓡwas introduced by Grunenthal GmbH in Germany between 2006 and 2009. It has flavored clarithromycin granules loaded into transparent polypropylene straw. The straw had a white cap on one side and a polyester/polyolefin plunger on the other. Clarosip^Ⓡ is available in different strengths of clarithromycin (125, 187.5, or 250 mg) and is recommended for acute and chronic respiratory infections, sinusitis, and chronic bronchitis [10]. Xstraw^Ⓡ,which wasintroduced by DS Technology GmbH, is composed of a multiparticulate system of drugs loaded into a straw for safe intake and perfect dosage for patients [11].

Vitasip^Ⓡ is a flavored straw developed by Vitecer Ltd. for delivering vitamins, minerals, herbal extracts, and pharmaceuticals. Fizzy tablets that are responsible for the intense flavor are embedded between the layers of active substance in the straw. These specialized straws have no loose elements, thus no solid grain can reach the mouth, and their use is safe. Viterip collagen complex is a beauty care flavored drinking straw, containing collagen and hyaluronic acid for the possible effect of reducing wrinkles due to the natural process of aging and air pollution. Selenium, vitamin E, and vitamin C protect the cells against oxidative stresses and help maintain the normal state and functioning of the skin [12]. HiccAway^TM is a straw-based product that relieves hiccups by generating enough pressure while sipping water from the device to lower the diaphragm and simultaneously activate the leaf-shaped flap in the throat. This stimulates two key nerves, including the phrenic and vagus nerves responsible for hiccups, thereby allowing the brain to rest and stop the hiccups [13].

Biodegradable polymers could be employed for developing medicated straws with customized properties with the advancement of three-dimensional printing technology. Edible straws could be another futuristic approach so pediatrics could eat the straw after use. The edible straws could be loaded with probiotics and immunity boosters for potential therapeutic assistive effects. Adequately addressed regulatory aspects of medicated straws may prove as an innovative drug delivery system for the pediatric patient population. In conclusion, medicated straws are innovative drug delivery systems to accurately deliver drugs, minerals, vitamins, probiotics,etc., to pediatric patients for better compliance and therapeutic efficacy.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Funding

This paper was not funded.