Comparison of buccal and oral prochlorperazine in the treatment of dizziness associated with nausea and/or vomiting

Buccally absorbed vs intravenous prochlorperazine for treatment of migraines headaches

OBJECTIVE

To compare the efficacy of buccally absorbed prochlorperazine (BAP) to intravenous prochlorperazine (IVP) for the abortive treatment of migraine headaches.

METHODS

Randomized double-blind trial. Eighty subjects aged 18-65 presenting with migraines to the ED of a safety-net, urban hospital. Subjects were randomized to receive either 6 mg BAP plus 2.25 mL saline IV placebo or 10 mg IVP and buccally absorbed saccharine pill placebo. A 100 mm visual analog scale (VAS) was used to assess pain, nausea, and sedation. Comparisons between groups were analyzed by the Mann-Whitney U test or Fisher's exact test.

RESULTS

Eighty subjects were recruited from November 2016 to December 2017; 79 completed the study. Demographics: 60 women and 19 men with a mean age of 38 ± 12.2 years. Initial mean VAS pain scores were similar between groups (BAP: 78.5 ± 19.9 mm vs IVP: 76.9 ± 19.5 mm). The improvement in mean VAS pain scores over 60 minutes for the BAP group was not significantly different from the IVP group (-54.9 ± 29.7 mm vs -66.7 ± 23.2 mm, respectively; P = 0.08). No significant differences were found in rates of nausea or sedation. Nine subjects in the BAP group required rescue treatment compared to 1 in the IVP group. Five subjects reported symptoms consistent with akathisia in the IVP group while no adverse effects were reported in the BAP group.

CONCLUSION

Buccally absorbed prochlorperazine (BAP) is an effective, non-invasive treatment for migraine headaches when compared to intravenous prochlorperazine (IVP).

Ambroxol Lozenge Bioavailability

OBJECTIVE

To examine whether or not the early dissolution/absorption in the oral cavity of lozenge administration contributes to superior bioavailability of ambroxol compared with the commercially available tablet.

METHODS

24-hour plasma level pharmacokinetic profiles of 20 healthy volunteers receiving oral administration of identical single doses (30mg) of lozenges and a commercially available tablet with a 1-week washout period were collected. The data were analysed by a non-compartmental model with a statistical moment and mean transit time concept. The mean transit times obtained after lozenge and tablet administration were compared.

RESULTS

The variance in absorption phase was significantly higher than that in the distribution/elimination phase in the pharmacokinetic profiles of the lozenge, suggesting additional absorption processes. The mean transit time of the tablet was significantly greater than that of the lozenge, by 7.69 hours with a 90% confidence interval (CI) of 3.11, 12.27. Early drug dissolution/absorption in the oral cavity and gastrointestinal absorption was successfully modelled to the pharmacokinetic profiles after lozenge administration. The additional availability of the drug to systemic circulation was mainly due to complete dissolution in the oral cavity prior to absorption as well as to oral mucosal transport. Between the two processes, dissolution was proposed to be a limiting step, since oral mucosal absorption was at a very high rate. The estimated average dissolution rate constant (90% CI) in first-order fashion was 0.13h(-1) (0.08, 0.32).

CONCLUSION

Absorption rates between lozenge and tablet could be differentiated with the aid of the mean transit time concept. However, estimation of oral mucosal absorption was not possible because the blood sampling intervals were not sufficiently frequent.

Anti-emetics for cancer chemotherapy-induced emesis: Potential of alternative delivery systems

Currently, the most commonly used routes of administration of antiemetics in chemotherapeutic regimens are oral and intravenous. Patient compliance and thus efficacy of conventional drug schedules and formulations are often impaired by difficulties associated with oral or intravenous uptake of the administered chemotherapy. Alternative or new drug delivery systems should overcome these problems by improving patient compliance. Several new drug delivery systems are available and development of these new systems is ongoing, in particular to meet delivery requirements of modern biological therapeutics and the application of gene therapy. However, at the present time, the implementation of new techniques of alternative antiemetic drug administration for chemotherapy-induced emesis is very limited. The challenge for clinical investigations to further develop new delivery systems, in particular for antiemetic therapies, remains.