A good Health is observed for global pharmaceutical sector with more than 1400 $Bn (1482 $ Bn, Key figures LEEM 2023) and a 2.1% growth compared to previous year. This market is expected to reach 1900 $ Bn by 2027 (excluded Covid vaccine) with major market for US (42.6%), China (7.6%), Japan (4.5%), Germany (4%), France (2.8%),Italy (2.4%), United Kingdom (2.3%) (1). Innovative drug forms target specifically Oncology (growth of 13% to 17% by 2027), Immunology and Diabetes (3rd largest growth 3-5% over next 5 years).The drug market has evolved for offering better products with great design adaptation in order to improve observance, a key challenge, especially for chronic disease. Definitely, the packaging, is established as a real partner for a better use; all the drug forms integrate evolution for formula (whatever the route of administration) with adaptation to all users (from the youngest to the elderly or disabled persons) (2).Pharmapack, one of the major events for Pharmaceutical packaging, presented new innovative trends in 2024 January, with a panel reflexion focused around Senses in Pharma; this short overview allows to make a point on what can be already seen and what can be proposed for going further (3).
A drug form remains a specific product in relation to its general definition of the Public Health Code: ‘a medicine is used to treat a disease’ with different rules whether it is a prescription drug (issued on prescription) or a free OTC (Over The Counter) product’ (4). In any case, it should be used wisely, avoid overconsumption, because any misuse can be dangerous. The pharmaceutical sector is highly regulated, and excessively diversified showing different routes of administration (a world separates the oral route from injectable forms); variability of release speeds (from a few minutes to several months), and of course, an extreme diversity of dosage forms (capsules, oral solutions, gels for external use, transdermal patches, nasal spray, pulmonary drug powder inhalers, injectable suspensions…). Such differences are not always understood by the general public – the majority but not the exclusive user – of the products, and the patient ‘the final consumer’ of the medicines is not the only one in contact with them. In fact, the prescriber will choose a treatment that the pharmacist will deliver and the caregiver will administer; taking all of these stakeholders into account is fundamental in order to properly classify the needs of each person without forgetting the type and duration of treatment. There is a big difference between the ‘one-off use’ (occasionnaly in an emergency) of a medication and a chronic treatment, established for the duration of life, sometimes. Helping with the proper use of medications, remains one of the major objectives of pharmaceutical packaging, keeping in mind that for being effective, a medication must be used correctly and all patients‘specificities (correlated to ages, disabilities) are essential and fortunately increasingly taken into account by Health industries (figure 1) (5). Compliance is one of the key challenges (nearly 50% of non-compliance as emphasized by WHO). Obviously, for being efficient, any drug form should be correctly used, all systems including packaging can be helpful and associate the senses for a better comprehension can be a great solution; let’s have a look on short overview.
The Taste, at first, is one fundamental sense largely taken into account, especially for younger children or babies. Suspensions, oral solutions remain the preferred choice for the young with the aroma -one major key element- for the treatment acceptance (6). From fruits with vanilla or chocolate, the choice can be dependent on the initial taste of the active substance and the disease to be treated (often citrus for vitamins). For children, the paradoxical challenge is to propose a sweet and tasty drug forms that do not induce overconsumption, even if childproofs systems are widely used (from caps to blisters or boxes, in more sustainable versions…) to avoid accidents (7). In addition, the aroma -so essential for the youngest- is also important for all adults (including seniors) in case of swallowing problem ; it is still a key factor in the adherence of long chronic treatments (sometimes to follow every day during life). Coating the tablets -or propose multiparticulate solid forms- can improve the swallowing. The idea of coating with an aroma that can be proposed as a real tool for identifying and memorizing the drug intake can be a solution. Keep in mind, that such an idea, is already observed for pulmonary administration for drug powder inhaler (DPI), where the aroma serves as a tracer of intake (numerous effective molecules efficient at very low dose) and helps to avoid overdosing. For primary packaging, the larger development of blister pulp pack can offer another solution for integrate a flavour in contact with the tablet, and thus to identify by taste, the taking of the treatment (figure 2).
On the Touch side,multiple adaptations to the ages are proposed with more ergonomic caps of pillbox (better climbing ring, different texture or an aid to the opening); the manufacturers multiply the systems, and thanks to the design, the tactile aspect is not forgotten. The touch offers also an aid to safety, as previously mentioned by childproof systems to limit the access of products, while offering better fitness adapted for the elderly. The combo childproof/senior friendly remains a winner well-design, both for primary or secondary pack. Injectable systems also multiply the offers of ‘pre-filled syringes’, ‘ready-to-use’ injectors and numerous ‘all-in-one’ simplified uses. Needles are often masked to avoid fear of injection; the shape is adapted to (sometimes) clumsy hands. Protective systems after injections, secure the use of syringes. In short, there is a wide development of chronic parenteral treatments, directly used by the patient himself (after sometimes training offered in the hospital or by caregivers) (8). An evolution always in development thanks to the growth use of injectable and targeted drug forms (market of combination products is expected to reach 133.3 $ Bn by 2027). Manufacturers do not forget to offer these training systems sometimes with the help of digital tools, for example via Digital Apps.
The Vision is definitely integrated into the Health Universe, for the secondary pack, as the recognition in the form of a drug is widely -and for a long time- used. Clear colours are associated with precise dosages, large character sizes are the preferred names and encrypted dosages; the secondary pack highlights this visual recognition. Then, the generics -from the beginning of their arrival on the market- were not lagging behind, by offering simple and clever packs, fully awarded by prizes, such as the Teva Pharmapack Patient Centricity dosing scale in 2015 (13). On secondary packaging, numerous pictograms, offer much information for an immediate visual identification of the age of the user, dosage, and dosage form. By showing the product, a real therapeutic education of the patient is achieved, an aspect studied and demonstrated as positive (14). Scientific studies have emphasized that specific colours are mainly associated with treatments, such as blue, green or purple, often proposed for antidepressant (blue and green associated with a tranquilizing effect). On the opposite red, yellow and orange are correlated with stimulant functions (15). The organizational aspect of pack on combined treatments, for complex therapies has been widely rewarded, the era of wallet box is definitely a ‘plus’ for compliance and a relay can be proposed by systems with digital tools (as example Körber Apps combine Augmented Reality for more information (16)). All tutorials, videos relayed by tags and Apps, take precedence to help patients, who become digital natives and request for this full integration of Digital (17).
Hearing is also present on Healthcare, mainly for parenteral administration, where audible clicks signalling the end of an injection; ‘beeps ‘announcing a successful suspension reconstitution; in short the end of the progress of a process can be heard clearly. For the pulmonary tract, these sound indications often emphasize the proper use of a DPI system and are essential. Tags on devices or packages can relay information or sound videos via Apps. ‘The box that speaks’ to the patient, that explain the use of the drug is now a reality possible thanks to the Digital (offered by many manufacturers); yes, definitely, hearing is a sense used, probably in development. In case of emergency, it is a valuable help as shown by hypo-allergenic product where all stages of use are relayed by sound, quite enough to reassure the patient stressed by an acute allergic problem (18)!
Finally, the smell, is certainly under used, especially if we consider that it is one of the most important, (demonstrated by a study of the Rockefeller Center) with an odour memorization for 35% against 5% for vision and only 2% for sound (19). The smell of a drug would undoubtedly benefit to be developed in formulations, with or without association with a specific taste, during external use. Smell as a mnemonic element of a catch, why not, and with the growth of paper blisters, can we imagine a paper blister that by desolating itself, would deliver a scent, specific marker of the treatment? For pillboxes, desiccant that delivers a fragrance can also be another proposal for using smell as mnemotechnic element.
Interconnection between senses has been revealed in various scientific studies that correlated shapes of pills with taste sensations. People can match basic taste words to typeface variation in roundness versus angularity (22). Other studies demonstrated that taste hedonic can influence the way in which people match the taste to shape (23). And then, in addition, showing pills in real size with specific colour (or combination colour for caps) provide a safe recognition and in the meantime allows a protection for limit counterfeiting. Definitely, all the senses are fully helpful for a better use of all drug forms and in the meantime a better compliance; this will be a fascinating story to follow.
Figure 1. Route of administration, drug forms, patients, diversities (2, 3).
Figure 2. The taste, use flavors for liquid forms (3, 7).
Figure 3. The touch, offering better uses’ adaptation (3, 7, 9, 10, 11, 12).
Figure 4. Vision for better compliance (3, 16).
Figure 5. Hear and Smell (3, 19, 20, 21).
References and notes
- https://www.leem.org/publication/bilan-economique-2022-2023-des-entreprises-du-medicament
- Gauthier P. ‘Packaging as a true partner for patients. Dream or reality.’ Chemistry Today, 2021, 39, 1, 30-32.
- https://www.cphi-online.com/from-sight-touch-taste-and-smell-to-hearing-the-file145505.html
- https://www.legifrance.gouv.fr/codes/article_lc/LEGIARTI000045404922
- Gauthier P. ‘More with less an established statement of the PharmaWorld. ‘2020, 38, 3, 48-49
- Draft Guideline on Pharmaceutical Development of Medicines for Paediatric Use; European Medicine Agency: London, UK, 2011; EMA/CHMP/QWP/180157/2011.
- Gauthier P. Cardot J-M. ‘Developing drugs for Developing Drugs for Children and the Adjustment of Medication—Is It a New Challenge or an Adaptation of Past Ideas? J. Pers. Med. 2011, 1(1), 5-16; https://doi.org/10.3390/jpm1010005
- Gauthier P. ‘A complete world of design adaptation and product specificities for injectable drug delivery.’ Therapeutic Delivery, 2017, 8, (11), 933-937.
- https://www.berryglobal.com/en/product/product-item/45mm-pp-criii-palmsoft-13181339
- https://www.healthcarepackaging.com/design-materials/materials/press-release/13289770/vetter-syringe-closure-system
- https://www.locked4kids.com/?gad_source=1&gclid=CjwKCAjwrcKxBhBMEiwAIVF8rPW35HtLWXCHuAdeb8iTNIHMBbrkAH1ZXotksB97smeflILxEWKzdRoC5L0QAvD_BwE
- https://www.schreiner-group.com/en/products/pharmaceutical-industry/needle-protection-system/
- https://www.lequotidiendumedecin.fr/archives/teva-lance-le-service-easyboxr
- Mercks P., Swieczkowski D., Balcerzak M. et Al. ‘Patient counselling service with the use of pictograms as the example of pharmacist intervention to improving compliance and medicine safety.’ Cardiology Journal, 2021, 28, 6. https://journals.viamedica.pl/cardiology_journal/article/view/7264
- Spence C. ‘the multisensorial design of pharmaceutical and their packaging.’ Foord quality and preference, 2021, 91, 104200 https://www.sciencedirect.com/science/article/abs/pii/S0950329321000276?via%3Dihub
- https://www.koerber-pharma.com/en/solutions/packaging-materials/smart-packaging
- Gauthier P. ‘Digital and Healthcare, a winning mix for users. ‘Chemistry Today, 2019, 37, 4, 50-52.
- https://www.auvi-q.com/about-auvi-q
- https://hi-riseservices.com/why-hi-rise/power-of-scent/
- https://www.red-dot.org/project/skytrofar-auto-injector-64014
- https://www.ompharmaservices.com/products/aidaptus-auto-injector/?gclid=CjwKCAjwp4m0BhBAEiwAsdc4aPRBfxSixdnhMnOOKlnVK2jLKe2J4f_1CMqQ6jPs1mWx_KQIhdLtbhoC-8EQAvD_BwE
- Wan X., Woods A., and Al. ‘Assessing the expectations associated with the pharmaceutical pill colour and shape.’ Food quality and preference, 2019, 45, 171-182 https://doi.org/10.1016/j.foodqual.2015.06.009
- Velasco C., Woods A.T and Al ‘the taste of typeface.’ 2015, I-perception, 6(4), 1-10. https://doi.org/10.1177/2041669515593040
