Flavor Plus versus Ora Plus

I'm looking for opinions on how these two products compare. 

 

The Humco Brand "Flavor" product line is so much less expensive than the Perrigo Brand "Ora" product line, I'd rather go the cheap route if there isn't much difference.     

 

And I see no indication how long these products last under refrigeration after opening.  Anybody know? 

       

I think you want to compare Flavor Plus with Ora Sweet since they're both flavored, sweetened drug delivery products.  Ora Plus isn't sweetened.

 

Flavor Plus and Ora Sweet look to be very nearly identical in their ingredients. 

 

I see reputable info claiming that suspensions made with Flavor Plus are often stable for over a month, so the product by itself must be stable for at least that long.  It's buffered at around pH 4, so most microbes won't grow in it.  You just have to be sure that the drug you're using it with isn't acid labile.

Hello, Koko Lee.

 

Are you asking about the shelf life of suspending vehicles?  If so, the article below might be of interest.  Here’s what the authors have to say about shelf life:

 

“Additionally, most of these oral vehicles are available in conveniently packaged one-pint containers (473 mL), with a 24- to 36-month shelf life. This allows the pharmacist to easily stock and store these buffered, sweetened, flavored, and preserved oral vehicles in their inventory.”  (p. 488)

 

Reference:

 

Cutaia, Kara; Chablani, Lipika; and Zhao, Fang (2018). "Basics of Compounding: Vehicles for Compounded

Oral Liquid Medications: A Review." International Journal of Pharmaceutical Compounding 22.6, 480-489. Accessed online at : https://fisherpub.sjfc.edu/cgi/viewcontent.cgi?article=1189&context=pharmacy_facpub

Thanks, badsocref!

 

I think you want to compare Flavor Plus with Ora Sweet since they're both flavored, sweetened drug delivery products.  Ora Plus isn't sweetened.

 

As I understand it, Flavor Plus and Flavor Sweet are the discount versions of Ora Plus and Ora Sweet, respectively.  Evidently, "Flavor Plus" is a misnomer, as it's "flavor-free", according to the product description. 

 

https://www.humco.com/pharmaceuticals/flavor-plus/

 

I see reputable info claiming that suspensions made with Flavor Plus are often stable for over a month, so the product by itself must be stable for at least that long.  It's buffered at around pH 4, so most microbes won't grow in it. 

 

Yes, clonazepam suspension is supposed to be stable for 60 days under refrigeration, so opened bottles of the suspension vehicles must also be good for at least 60 days if refrigerated.  I'm just curious how much longer than that they'll keep, assuming I avoid contaminating them. 

             

Hello, Koko Lee.

 

Are you asking about the shelf life of suspending vehicles?  If so, the article below might be of interest.  Here’s what the authors have to say about shelf life:

 

“Additionally, most of these oral vehicles are available in conveniently packaged one-pint containers (473 mL), with a 24- to 36-month shelf life. This allows the pharmacist to easily stock and store these buffered, sweetened, flavored, and preserved oral vehicles in their inventory.”  (p. 488)

 

Hi Libertas!  Thanks for the link!

 

Hoping the long shelf life applies to opened bottles as well as sealed ones.  The products are formulated to discourage growth of bacteria, yeasts, and molds, so we'll see how they look when the time comes.  If we have any doubt, we'll buy new.

   

 

You are most welcome, Koko Lee! The 24-36 month shelf life for unopened bottles certainly suggests that commercial suspending vehicles are formulated to “withstand the test of time.”  Plus I have no doubt you will take all possible precautions to avoid contamination.

 

While we’re on the topic of Beyond Use Dates, have you encountered the following paper in your research?  On the outside chance you haven’t, you might find Table 5 of interest.

 

Allen LV Jr., Erickson MA. Stability of acetazolamide, allopurinol, azathioprine, clonazepam, and flucytosine in extemporaneously compounded oral liquids. Am J Health-Syst Pharm. 1996;53(16):1944-1949.

https://www.perrigorx.com/pdfs/Sec%20Artem%205.4.pdf

You are most welcome, Koko Lee! The 24-36 month shelf life for unopened bottles certainly suggests that commercial suspending vehicles are formulated to “withstand the test of time.”  Plus I have no doubt you will take all possible precautions to avoid contamination.

 

While we’re on the topic of Beyond Use Dates, have you encountered the following paper in your research?  On the outside chance you haven’t, you might find Table 5 of interest.

 

Allen LV Jr., Erickson MA. Stability of acetazolamide, allopurinol, azathioprine, clonazepam, and flucytosine in extemporaneously compounded oral liquids. Am J Health-Syst Pharm. 1996;53(16):1944-1949.

https://www.perrigorx.com/pdfs/Sec%20Artem%205.4.pdf

 

Wow, Libertas, you have no idea how helpful Table 5 is!

 

The compounding methods I've seen all indicated that clonazepam suspensions must be refrigerated, but this study shows that the suspension is relatively stable at room temperature.  So if it's left out of the fridge for a day or two or three, we won't have to throw it away and start over.  Glad we don't need to be neurotic about keeping it cold.

 

It also appears that the Sugar-Free Ora Sweet is at least as stable as the regular Ora Sweet.  I was wondering which of these products to use.  Ordinarily I would avoid artificial sweeteners, but since my partner suffers from Benzo Belly and IBS of the constipating variety, the laxative effects of sugar alcohols might be a boon, especially in the tiny amounts he will be taking.  If the sugar-free kind produces an equally stable suspension, all the better! 

 

Lastly, I was surprised to see that the researchers used plastic prescription containers instead of amber glass.  I was aware that certain plastics were contraindicated for use with clonazepam suspension, but I wasn't sure which ones.  Your post prompted me to look for that info, and here's what turned up:  https://link.springer.com/article/10.1007/BF01980044

 

Published: October 1990

Comparison of clonazepam sorption to polyvinyl chloride-coated and polyethylene-coated tubings

P. M. Hooymans, R. Janknegt & J. J. H. M. Lohman

Pharmaceutisch Weekblad volume 12, pages188–189(1990)Cite this article

 

Abstract

The sorption of clonazepam to polyvinyl chloride tubing, polyethylene-coated tubing and to a polyethylene syringe was determined. Pumping of clonazepam (5 mg/48 ml) through the polyvinyl chloride tubing with flow rates of 2 ml/h and 4 ml/h resulted in a reduction of the clonazepam concentration to about 40% and 55% of the original strength after 0.6 h, respectively. This value was 55% at a flow rate of 2 ml/h and a clonazepam concentration of 10 mg/48 ml. The effluent clonazepam concentration increased gradually after an infusion period of 1 h. Sorption of clonazepam to the polyethylene syringe and to the tubing coated on the inside with polyethylene does not occur. The use of polyethylene-coated administration sets is recommended for intravenous administration of clonazepam. 

 

Fortunately, the syringes and syringe adaptor fittings we plant to use are polyethylene.  As for PVC, I believe it's now a proven carcinogen, so its tendency to absorb clonazepam is probably the least of one's worries.  But I guess back in the 90s when the research was conducted, the use of PVC in food, drink and medical applications had not yet been banned.

 

On a related note, I looked into those amber plastic prescription liquid bottles like the ones my partner's liquid citalopram comes in.  It appears they're made of PETE (Polyethylene terephthalate)--a plastic with endocrine-disrupting properties.  Yum.  Maybe the pharmacy would start putting the liquid citalopram in amber glass if we asked them to....

 

Anyway, a thousand thanks, Libertas!  You rock! 

   

Greetings, Koko Lee.  Your post has started my day on a high note!  I’m so glad the paper was helpful.  Your research skills are impressive — you’re the first member I’ve encountered who has delved into the literature regarding clonazepam and plastics. Libertas