Sex Differences in Medicine Acceptability: A New Factor to Be Considered in Medicine Formulation

Abstract

Palatability is a recognized driver of medicine acceptability in pediatrics but deemed less relevant in older populations due to sensory decline. Preliminary findings from an observational study implicated palatability problems with one Alzheimer's medicine. Among 1517 observer reports combining multiple measures on medicines uses in patients aged over 64, we focused on two original formulations of memantine (Ebixa^®, tablets (n = 25) and oral solution (n = 60)). Evaluations were scored with an acceptability reference framework (CAST), the rodent Brief Access Taste Aversion (BATA) model tested aversiveness. Focusing on women treated with Ebixa^® (n = 54), the oral formulation sub-group was classified as "negatively accepted", while the coated tablet was associated with the "positively accepted" cluster. In men, both formulations belonged to the "positively accepted" profile. Using BATA, the original oral solution was categorized as highly aversive/untolerated while solutions of excipients only were well tolerated. Furthermore, the number of licks was significantly lower in female than in male rats. These results revealed that medicine palatability remains important for acceptability in older populations. Moreover, converging results from humans and animal models highlighted that palatability profiles can significantly vary between the sexes. These drivers should be closely considered during drug development to enhance acceptability in this population.

Keywords: Alzheimer; CAST—clinsearch acceptability score test; acceptability; brief-access taste aversion; formulation; medicine; older population; palatability; sex; taste assessment.

Figure 1

Acceptability of the original formulations of memantine (Ebixa^®) in the older population.

Figure 2

Acceptability of the original formulations of memantine (Ebixa^®) in older women.

Figure 3

The aversiveness of test solutions for male and female rats. The average lick number for each dilution of placebo and original oral solution of memantine (Ebixa^®) for male and female rats ± Standard Error of the Mean (SEM), with the average lick number of water shown as a solid red line ± SEM.