[KeRSI]

Hello all,

I am here to ask about an issue I have with an excipient. I have some amoxicillin with clavulanic acid that I was prescribed, and it contains the usual offender, titanium dioxide. I would like to know whether there would be any simple household substance which could aid in removing this compound from the active ingredients, for example by precipitating it or making it harder for it to go through a paper filter. I am thinking about what effect an acidic or alkaline environment would do to it, however my chemistry knowledge is quite limited. I know the titanium is usually micronized when added but I am hopeful, having already managed to remove most of the telltale white suspension from water I dissolved a tablet in, with the help of said paper filter.

Thank you so much for your time!

[Corribus]

offender

I'll bite. Why an "offender"?

[KeRSI]

offender

I'll bite. Why an "offender"?

Well, I will be honest and say that I figured not calling it anything would probably have risked sparking even more interest in my motives. Alas, these supposedly inert substances readily cross the intestinal wall (as does undegraded starch I'm sure). Meanwhile some amount of research happily goes on, its spirit clean thanks to the "impregnable" intestinal barriers. A few examples: http://www.ncbi.nlm.nih.gov/pubmed/16903269 http://www.sciencedirect.com/science/article/pii/S037842741001684X http://www.sciencedirect.com/science/article/pii/S0278691513002421

But other than that, I would like to save the precious metal for places other than my own body, especially considering the need our gracious leaders have for even deadlier flying contraptions. Also why do we need nine different fillers to pack a simple tablet? Frankly I wouldn't mind if it were not completely tasteless, or not precisely white  . Or if it didn't give me a nasty brain fog. Thank you for your interest. Apologies for posting in the wrong section.

[Corribus]

I'll do my best to not go off on a rant, because I don't know what kind of ears I'm talking to, but here are a few things to consider.

1. These studies were done on nanoparticles. It is widely understood that the toxicity of nanoparticles often differs from larger particles, although the reason is not widely agreed upon. Nanoparticle toxicology is a very active and contentious area at the moment, with gazillions of often conflicting studies. Aside from the lack of consensus on findings, there is a lack of consensus on appropriate methodology to use. The most important thing is that the titanium dioxide in pills and most other consumer products is not nanoscale. Certainly in a drug format, in the US nothing would be allowed into those pills that hasn't been proven by a ridiculously rigorous set of protocols to be safe and effective for intended use.

2. These studies are in vitro studies, which means they are for the most part done on isolated cell lines. This does not necessarily (and in fact probably doesn't) correlate into toxicity in vivo. Especially oral toxicity. You need actual oral ingestion studies to determine that. And even if you can demonstrate that titanium dioxide does get absorbed into the bloodstream, the form of the titanium that is absorbed is very important (as shown above). There are a lot of examples of substances that are toxic to isolated cell lines but non-toxic when ingested, either because the substance just passes through or because it is absorbed in a form whose toxicity is different from that used in the in vitro assays. There are plenty of examples for nanoparticles in fact. The stomach is such a harsh environment for just about anything.

(Just so you're aware, there are a lot of different forms of titanium dioxide that differ not only in their particle size but their crystal structure. TiO2 comes in what is called "rutile", "anatase", amorphous, etc., and they all differ quite a bit in their chemical properties. Without knowing what form the titania is in your pills, it's impossible to know if those studies are even relevant at all.)

Anyway, certainly you should do what you feel is right, but I think your fears are unwarranted. I don't think the studies you linked to are relevant at all - at the least, I certainly wouldn't jump to any conclusions from such a small body of literature that may not have anything to do with the TiO2 you are deliberating over. Having been closely involved it, I have utmost faith in the legal process to ensure that drugs are overwhelmingly safe, provided they are used as intended, at least in the US.

Regarding your question about separation - I don't know the answer. Be aware that anything you do has the chance to completely change the composition and form of the active ingredient in the pill. Some of the binders that are added are there to mediate intestinal absorption of the drug. Even if you are successful at removing the TiO2, you might actually change the pharmacokinetic properties of the drug, and thereby make it dangerous to use or risk an overdose. Drugs are precisely formulated to be absorbed at a specific rate.

Personally I'd leave well enough alone or see if the pharmacist has the drug available in another formulation that meets you specifications. But we don't offer medical advice here so I'll leave it at that.

[KeRSI]

I am seeing products with less than half of the fillers, although I don't think there is a procedure to hand it back in for a new prescription (it is very much "take what you get"). I say, without a precautionary principle being implemented at more local levels than is required by written law, where would humanity be today?

[Arkcon]

I don't believe its feasible to remove a carefully compounded component easily.  Pharmaceutical components, excipients are carefully graded, and mixed thoroughly to prevent them separating.  And its likely practically hopeless to do this with home chemicals.  This is an academic question anyway -- we have a rule, on this forum, not to discuss homemade medicines for self-medication, for liability reasons.  Now you might want to say that you're not making medicine, just changing a made one.  But this isn't much of a distinction.  You will likely lose at least some active in the process, changing dosage.  You may destroy active in the process, or ruin its absorbability.  And there will likely be residual reagents from your erstwhile purification.

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