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Guide Health: Your drugs and technology

There has been considerable change as to how medications are administered over the years

Technology seems to be everywhere these days, and your drugs are no exception. At one time drugs were dispensed as powders in powder papers. You would open up the folded paper, dump the powdered drug into a beverage, and then drink the beverage.

Now there are tablets, capsules, liquids, and even suppositories, which are all manufactured in pharmaceutical plants to ensure sterility and uniformity of dose.

Even among modern day pharmaceuticals, there are technological improvements. Your stomach contains acid which can destroy some drugs, which is why specialized tablet coatings have been developed to protect tablets, allowing them to pass to the small intestine where they are broken down and absorbed.

New technologies can bring new warnings, however. In this case, enteric coating (or “EC”) has the drawback that the tablets must be swallowed whole. Crushing or breaking the tablet destroys the coating.

Another example is prodrug technology. These are drugs that are taken in one form which your body converts into an active form. For example, you take enalapril for your blood pressure and your liver metabolizes it to the active form of enalaprilat, or you take levodopa for Parkinson’s disease and it crosses into your brain where it is metabolized to dopamine, the treatment for Parkinson’s disease.

Transdermal or patch technology enables your body to absorb medication through your skin. In the case of some patches, for example birth control patches, the technology means you don’t need to remember to take your birth control pill each day, just to change your patch once a week.

Nicotine replacement therapy for smoking cessation, nitroglycerin patches for heart pain or angina, and even fentanyl pain patches gradually release medication over time, resulting in steady blood levels.

And, by using patch technology, your medication is absorbed directly into your blood stream rather than having to pass through your stomach where absorption can be variable and where side effects like stomach irritation can happen.

When a drug is absorbed, there will be a peak blood level which slowly declines until the next dose of the drug. Ideally, if you need to take any drug on a routine basis, you want even blood levels, not the fluctuations.

This is the aim of controlled release, slow release, and extended release formulations. Many drugs have CR, SR, or XL options with once-daily dosing and steady blood levels. Again, you cannot crush or break these formulations since that destroys the technology that enables them to be active over 12 or even 24 hours.

The most recent technological advancement has been with genetics and drugs. It makes sense that your genes affect how your body handles drugs. You may be a “fast” or “slow” metabolizer of drugs, which means that you need dosage adjustments. For example “fast” metabolizers of narcotics need higher doses more often to alleviate pain.

Potentially more important in this regard, however, is targeted therapy. The idea is that you have a specific genetic makeup which will mean that you will benefit from a specific type of drug or that there is one that you should avoid.

Targeted gene therapy is starting to be used in cancer therapy. For example prembrolizumab (Keytruda) works with your immune system to fight certain types of cancer, but it is only effective if you have specific genes.

The next technological advances may be blood glucose testing systems. The technology has been developed that allows for an adhesive “tester” to be applied directly to your skin, rather than needing to take a blood sample. Regardless, stay tuned, because the next technological advance is probably just around the corner!

About the author

Contributor

Marie Berry is a lawyer/pharmacist interested in health and education.

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