Topical & Transdermal Medications in Palliative Medicine
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This document discusses various routes of medication administration and provides examples of topical and transdermal medications. It summarizes that topical medications treat localized areas while transdermal medications provide systemic delivery. Several branded and compounded topical and transdermal medications are listed along with their indications and evidence bases.
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Topical & Transdermal Medications in Palliative Medicine
- 1. Topical & Transdermal Medications Christian Sinclair, MD Kansas City Hospice & Palliative Care October 8, 2008
- 6. Variations
- 29. Source: Duragesic package insert
- 30. Source: Duragesic package insert
Notes de l'éditeur
- By definition, topical drugs used to control pain will act locally on damaged or dysfunctional soft tissues or peripheral nerves. Topical delivery systems differ from transdermal delivery systems in that they target a site immediately adjacent to the site of delivery rather than using the skin as an alternate systemic delivery system. FDA identifies 111 official routes of medication administration: http://www.fda.gov/cder/dsm/DRG/drg00301.htm including other and not applicable
- Stratum corneum poses a formidable challenge to drug delivery systems
- Also CaJo Anes compared dicolfenac versus EMLA 54:196-200
- Cochrane database – amethocaine is better Also lmx which is lidocaine only
- Cochrane review Lander JA, Weltman BJ, So SS. EMLA and Amethocaine for reduction of children's pain associated with needle insertion. Art. No.: CD004236. DOI: 10.1002/14651858.CD004236.pub2.
- http://www.eperc.mcw.edu/FastFactPDF/Concept%20185.pdf
- Pain. 1999 Mar;80(1-2):121-5.Links Potential uses of topical opioids in palliative care--report of 6 cases. Krajnik M , Zylicz Z , Finlay I , Luczak J , van Sorge AA . Department of Palliative Care, The Ludwig Rydygier Medical University, Bydgoszcz, Poland. Opioids used topically may exercise several useful clinical effects. Opioids may cause immediate local analgesia and also may work indirectly through decreasing the inflammation process. In this article we describe six patients treated with topical opioids because of cutaneous pain due to tumor infiltration. skin ulcers of malignant and non-malignant origin, severe oral mucositis, pain due to knee arthrosis and severe tenesmoid pain. In all but one case, topical morphine provided rapid relief which lasted usually for 7-8 h. The side effects of topical opioids were none or minimal. Possible mechanisms of topical analgesia are discussed. 2% morphine solution
- Morphine Bioavailability from a Topical Gel Formulation in Volunteers . Journal of Pain and Symptom Management , Volume 35 , Issue 3 , Pages 314 - 320 J . Paice , J . Von Roenn , J . Hudgins , L . Luong , T . Krejcie , M . Avram Although available therapies provide relief to many patients with cancer-related pain, swallowing difficulties or intestinal obstruction may preclude oral analgesic delivery in some. Topical morphine might provide an alternate delivery form but morphine bioavailability from a topical gel formulation has not been reported in humans. We conducted a randomized, placebo-controlled, double-blind, crossover study of five volunteers after they provided institutionally-approved, written, informed consent. They were admitted to the Northwestern University General Clinical Research Center twice, being randomly assigned to receive either 1mL of morphine compounded at 10mg/mL in pluronic lecithin organogel (PLO) base applied to the wrist and 1mL of normal saline administered subcutaneously, or 1mL of topical drug-free PLO base and 1mL of subcutaneous morphine, 3mg/mL, the first time and the opposite combination the second. Seventeen blood samples were collected from 5minutes to 10hours after dose administration for morphine concentration determination. Plasma samples were prepared by solid-phase extraction and morphine concentrations measured by a mass spectrometric technique with a linear range of 0.5–500ng/mL. Bioavailability of the topical formulation relative to the subcutaneous dose was to be estimated from doses and the plasma morphine concentration versus time relationships. Because morphine was seldom detected in plasma samples after topical administration and was unquantifiable when it was, the low bioavailability of topical morphine was unquantifiable. These results suggest that topical administration of morphine compounded in a PLO base for transdermal drug delivery is unlikely to provide relief of cancer-related pain.
- 3 patients had dementia, and the patients could not use pain scales, so the staff rated their pain.
- Case reports of toxicity in children with VZV Bernhardt DT. Related Articles , Links Topical diphenhydramine toxicity. Wis Med J. 1991 Aug;90(8):469-71. PMID: 1926887 [PubMed - indexed for MEDLINE] 4: Chan CY, Wallander KA. Related Articles , Links Diphenhydramine toxicity in three children with varicella-zoster infection. DICP. 1991 Feb;25(2):130-2. Review. PMID: 2058184 [PubMed - indexed for MEDLINE] 5: 2: Int J Pharm. 2001 Oct 9;228(1-2):79-87. Links Evaluation of in vitro percutaneous absorption of lorazepam and clonazepam from hydro-alcoholic gel formulations. Puglia C , Bonina F , Trapani G , Franco M , Ricci M . Department of Pharmaceutical Sciences, School of Pharmacy, University of Catania, Viale Andrea Doria no. 6, 95125, Catania, Italy. boninaf@mbox.unict.it Nokhodchi A , Shokri J , Dashbolaghi A , Hassan-Zadeh D , Ghafourian T , Barzegar-Jalali M . School of Pharmacy, Tabriz Medical Sciences University, Tabriz, Iran. nokhodchia@hotmail.com Huston RL, Cypcar D, Cheng GS, Foulds DM. Related Articles , Links Toxicity from topical administration of diphenhydramine in children. Clin Pediatr (Phila). 1990 Sep;29(9):542-5. No abstract available. PMID: 2242650 [PubMed - indexed for MEDLINE] 2003 albino rats in india with a TDDS Drug Dev Ind Pharm. 2003 Apr;29(4):405-15.Links Transdermal drug delivery system of haloperidol to overcome self-induced extrapyramidal syndrome. Samanta MK , Dube R , Suresh B .
- Topical capsaicin preparations of 0.025 and 0.075% Postherpetic neuralgia Bernstein et al., 1989;Watson et al., 1993 Diabetic neuropathy Capsaicin Study Group, 1992 Postmastectomy pain syndrome Watson and Evans, 1992; Dini et al., 1993 Oral neuropathic pain, Trigeminal neuralgia, and TMJ disorders Epstein and Marcoe, 994; Hersh et al., 1994 Cluster headache (following intranasal application) Marks et al., 1993 Osteoarthritis McCarthy and McCarthy, 1992 Dermatological/cutaneous conditions Hautkappe et al., 1998