1
|
Hirayama I, Kamijo Y, Nonaka M, Yano T, Ishii M, Tominaga Y. Sublingual administration of atropine eye drops for treating organophosphorus poisoning. Clin Case Rep 2024; 12:e8762. [PMID: 38681030 PMCID: PMC11052684 DOI: 10.1002/ccr3.8762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/08/2024] [Accepted: 03/16/2024] [Indexed: 05/01/2024] Open
Abstract
An 89-year-old patient with fenitrothion toxicity received sublingual atropine eye drops, reducing the intravenous atropine requirement. This alternative method enabled rapid rehabilitation, and he walked unaided, leading to discharge.
Collapse
Affiliation(s)
- Ichiro Hirayama
- Department of Clinical Toxicology, Faculty of MedicineSaitama Medical UniversitySaitamaJapan
- Department of Emergency MedicineNational Hospital Organization Saitama HospitalSaitamaJapan
| | - Yoshito Kamijo
- Department of Clinical Toxicology, Faculty of MedicineSaitama Medical UniversitySaitamaJapan
| | - Minaho Nonaka
- Department of Emergency MedicineNational Hospital Organization Saitama HospitalSaitamaJapan
| | - Tetsuhiro Yano
- Department of Emergency MedicineNational Hospital Organization Saitama HospitalSaitamaJapan
| | - Mitsuru Ishii
- Department of Emergency MedicineNational Hospital Organization Saitama HospitalSaitamaJapan
| | - Yoshiteru Tominaga
- Department of Emergency MedicineNational Hospital Organization Saitama HospitalSaitamaJapan
| |
Collapse
|
2
|
Tarlovski S, Bar Kadmon A, Goldberg E, Segal D, Gavish D, Stepensky D. Comparative Pharmacokinetic Assessment of Innovative Sublingual, Rectal and Vaporizer Cannabis Products Versus Approved Cannabis Products in Healthy Volunteers. Cannabis Cannabinoid Res 2024. [PMID: 38656906 DOI: 10.1089/can.2023.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Background: Over the last years, there is a dramatic increase in the use of medical cannabis products for an expanding range of clinical indications. The type of the drug product and its administration route affect substantially the rate and the extent of absorption of cannabinoids and the effects induced by them in the patients. The current challenge for the cannabis pharmaceutical industry is to develop formulations that allow predictable and stable absorption of cannabinoids. This article reports the results of the clinical trial that investigated the pharmacokinetics (PKs) of innovative cannabis products in healthy volunteers. Materials and Methods: This was a single-center study with a single-dose, randomized, crossover, partially blinded controlled design. Each of the 12 healthy volunteers received 8 different products, of the 10 products that were assessed in this trial: novel sublingual (SL) tablet, vaporizer, and rectal products, comparator products (Sativex® and oil-based oromucosal products), and placebo products. Serial blood samples were collected, plasma concentrations of the THC, 11-OH-THC, and CBD were quantified and subjected to noncompartmental PK analysis. Results: Novel medical cannabis products that were investigated in the study induced substantial exposure of the volunteers to the active ingredients, had more rapid absorption, and in some cases also less variable absorption of THC and CBD, in comparison with the approved comparison products. The bioavailability of the novel SL tablet-based and suppositories products was somewhat lower than that of the oromucosal products. The vaporizer provided immediate systemic absorption with highest maximal concentration. The safety profile of the novel cannabis products, namely vaporizer, SL tablets, and suppositories, was not inferior to the Sativex and oil-based oromucosal formulations. Conclusions: The novel cannabis products that were assessed in this study have PK properties that may be advantageous for management of specific medical conditions or in specific subgroups of patients that are prescribed medical cannabis.
Collapse
Affiliation(s)
| | | | | | - Dadi Segal
- Panaxia Pharmaceutical Industries Ltd., Lod, Israel
| | - Dov Gavish
- Department of Medicine, Edith Wolfson Medical Center, Holon, Israel, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - David Stepensky
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| |
Collapse
|
3
|
De Cuyper H, Poelaert J. Microcirculatory Alterations in Cardiac Surgery: A Comprehensive Guide. J Cardiothorac Vasc Anesth 2024; 38:829-838. [PMID: 38195271 DOI: 10.1053/j.jvca.2023.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/09/2023] [Accepted: 11/29/2023] [Indexed: 01/11/2024]
Abstract
Microcirculation is essential for cellular life and its functions. It comprises a complex network of capillaries, arterioles, and venules, which distributes oxygenated blood across and within organs based on regional metabolic demands. Because previous research indicated that organ function is linked to microcirculatory function, it is crucial to maintain sufficient and effective microcirculatory function during major surgery. Impaired microcirculation can lead to inadequate tissue perfusion, potentially resulting in perioperative complications and an unfavorable outcome. Indeed, changes in microcirculation in cardiovascular disease and cardiac surgery have a direct correlation with prolonged stays in the postoperative intensive care unit and high mortality rates within 30 days. Additionally, cardiopulmonary bypass, a regularly employed method in cardiac surgery, has been proven to induce microcirculatory malfunction and, thus, lead to postoperative multiple organ dysfunction. As global hemodynamic parameters can remain stable or improve, whereas microcirculation is still compromised, tracking microcirculatory variables could lead to the development of targeted microcirculatory treatment within hemodynamic management. Therefore, it is necessary to enhance the use of microcirculatory monitoring in the medical domain to assist physicians in the therapeutic management of patients undergoing cardiac surgery. This potentially can lead to better hemodynamic management and outcomes. This review article concentrates on the use of handheld video microscopes for real-time microcirculatory assessment of cardiac surgery patients in the immediate and early postoperative period. Emphasis is placed on integrating microcirculatory monitoring with conventional hemodynamic monitoring in the therapeutic management of patients undergoing cardiac surgery.
Collapse
Affiliation(s)
- Hélène De Cuyper
- Department Anesthesiology and Perioperative Medicine, UZ Brussels, Brussels, Belgium; Free University Brussels VUB, Brussels, Belgium.
| | - Jan Poelaert
- Free University Brussels VUB, Brussels, Belgium; Department Anesthesiology, ICU and Chronic Pain Therapy, Maria Middelares, Ghent, Belgium
| |
Collapse
|
4
|
Darchini-Maragheh E, Rees H, Moussa A, Bokhari L, Jones L, Sinclair R. Role of systemic minoxidil in the treatment of alopecia areata: A scoping review to direct future research. J Am Acad Dermatol 2024:S0190-9622(24)00419-5. [PMID: 38423467 DOI: 10.1016/j.jaad.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/21/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Emadodin Darchini-Maragheh
- Faculty of Medicine, University of Melbourne, Victoria, Australia; Sinclair Dermatology, East Melbourne, Victoria, Australia
| | - Huw Rees
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | - Anthony Moussa
- Sinclair Dermatology, East Melbourne, Victoria, Australia.
| | - Laita Bokhari
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | - Leslie Jones
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | - Rodney Sinclair
- Faculty of Medicine, University of Melbourne, Victoria, Australia; Sinclair Dermatology, East Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Vogelberg C, Gerstlauer M. AIT in pediatric allergology: Opportunities and difficulties on the home stretch of the Therapy Allergen Ordinance. Allergol Select 2023; 7:236-241. [PMID: 38143936 PMCID: PMC10740145 DOI: 10.5414/alx02443e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/04/2023] [Indexed: 12/26/2023] Open
Abstract
Allergen immunotherapy (AIT) is the only causal therapy for allergic diseases and therefore particularly important. Allergen preparations have been classified as medicinal products since 1989 (Directive 89/342/EEC) and were taken over into Directive 2001/83/EC in 2001. In addition, in 2008 the Therapy Allergen Ordinance (TAO) came into force to stricter regulate the exception for named patient products (NPP) by exclusion of common therapy allergens from the exception to be marketed as NPP. The TAO regulates the requirements for testing safety and efficacy for these common therapy allergens. Due to the long transitional provisions, the last deadlines for solving clinical shortcomings will end in 2026. The advantage of this regulation is that the market for common allergens has been cleared of products without proof of efficacy, and new preparations with an optimal dose range are developed through dose-finding studies. The demand for long-term pediatric studies has been outlined by the standard Pediatric Investigation Plan (PIP) on allergen products from the Pediatric Committee of the EMA (PDCO). This is particularly problematic, as it is foreseeable that recruitment of patients will be limited and ethical problems arise from the prolonged use of placebo. Furthermore, many newly approved preparations will not be used in pediatrics for the foreseeable future, as no marketing authorization has yet been granted for this age group. This will result in a serious supply gap for children.
Collapse
Affiliation(s)
- Christian Vogelberg
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, and
| | - Michael Gerstlauer
- Pediatric and Adolescent Medicine, University Hospital Augsburg, Augsburg, Germany
| |
Collapse
|
6
|
Fathy Elhabal S, El-Nabarawi MA, Abdelaal N, Elrefai MFM, Ghaffar SA, Khalifa MM, Mohie PM, Waggas DS, Hamdan AME, Alshawwa SZ, Saied EM, Elzohairy NA, Elnawawy T, Gad RA, Elfar N, Mohammed H, Khasawneh MA. Development of canagliflozin nanocrystals sublingual tablets in the presence of sodium caprate permeability enhancer: formulation optimization, characterization, in-vitro, in silico, and in-vivo study. Drug Deliv 2023; 30:2241665. [PMID: 37537858 PMCID: PMC10946264 DOI: 10.1080/10717544.2023.2241665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/12/2023] [Indexed: 08/05/2023] Open
Abstract
Canagliflozin (CFZ) is a sodium-glucose cotransporter-2 inhibitor (SGLT2) that lowers albuminuria in type-2 diabetic patients, cardiovascular, kidney, and liver disease. CFZ is classified as class IV in the Biopharmaceutical Classification System (BCS) and is characterized by low permeability, solubility, and bioavailability, most likely attributed to hepatic first-pass metabolism. Nanocrystal-based sublingual formulations were developed in the presence of sodium caprate, as a wetting agent, and as a permeability enhancer. This formulation is suitable for children and adults and could enhance solubility, permeability, and avoid enterohepatic circulation due to absorption through the sublingual mucosa. In the present study, formulations containing various surfactants (P237, P338, PVA, and PVP K30) were prepared by the Sono-homo-assisted precipitation ion technique. The optimized formula prepared with PVP-K30 showed the smallest particle size (157 ± 0.32 nm), Zeta-potential (-18 ± 0.01), and morphology by TEM analysis. The optimized formula was subsequently formulated into a sublingual tablet containing Pharma burst-V® with a shorter disintegration time (51s) for the in-vivo study. The selected sublingual tablet improved histological and biochemical markers (blood glucose, liver, and kidney function), AMP-activated protein kinase (AMPK), and protein kinase B (AKT) pathway compared to the market formula, increased CFZ's antidiabetic potency in diabetic rabbits, boosted bioavailability by five-fold, and produced faster onset of action. These findings suggest successful treatment of diabetes with CFZ nanocrystal-sublingual tablets.
Collapse
Affiliation(s)
- Sammar Fathy Elhabal
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Modern University for Technology and Information (MTI), Mokattam, Cairo, Egypt
| | - Mohamed A El-Nabarawi
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Nashwa Abdelaal
- Department of Integrative Physiology, Baylor College of Medicine, Houston, Texas, USA
| | - Mohamed Fathi Mohamed Elrefai
- Department of Anatomy, Histology, Physiology and Biochemistry, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
- Department of Anatomy and Embryology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shrouk A. Ghaffar
- Medical Affairs Department, Caduceus Lane Healthcare, Alexandria, Egypt
| | - Mohamed Mansour Khalifa
- Department of Human Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of Human Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Dania S. Waggas
- Department of Pathological Science, Fakeeh College for Medical Science, Jeddah, Saudi Arabia
| | | | - Samar Zuhair Alshawwa
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Essa M. Saied
- Chemistry Department, Faculty of Science, Suez Canal University, Ismailia, Egypt
- Institute for Chemistry, Humboldt Universität zu Berlin, Berlin, Germany
| | - Nahla A. Elzohairy
- Air Force Specialized Hospital, Cairo, Egypt
- Department of Microbiology and Immunology, Faculty of Pharmacy, Modern University for Technology and Information (MTI), Mokattam, Cairo, Egypt
| | - Tayseer Elnawawy
- Department of pharmaceutics, Egyptian Drug Authority, Cairo, Egypt
| | - Rania A. Gad
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Nahda University, Beni-Suef (NUB), Beni-Suef, Egypt
| | - Nehal Elfar
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Horus University, New Damietta, Egypt
| | - Hanaa Mohammed
- Human Anatomy and Embryology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | | |
Collapse
|
7
|
Malekpour H, Noori A, Abdi S, Abbasinazari M, Mahboubi A, Abiyar Ghamsari M. Is the Addition of Sublingual Melatonin to Omeprazole Superior to Omeprazole Alone in the Management of Gastroesophageal Reflux Disease Symptoms: A Clinical Trial. Turk J Gastroenterol 2023; 34:1206-1211. [PMID: 37768310 PMCID: PMC10765200 DOI: 10.5152/tjg.2023.23021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/22/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND/AIMS Proton pump inhibitors are frequently used to treat gastroesophageal reflux disease, but their effect is restricted. The present study aimed to investigate whether the addition of sublingual melatonin to omeprazole was effective in the treatment of gastro gastroesophageal reflux disease symptoms. MATERIALS AND METHODS This was a randomized double-blind clinical trial. A total of 78 patients with gastro gastroesophageal reflux disease were randomly allocated to either omeprazole 20 mg/d plus sublingual melatonin (3 mg/d) or omeprazole 20 mg/d plus placebo for 4 weeks. The selected patients had histories of heartburn and regurgitation and a score ≤32 on the Frequency Scale for the Symptoms of gastroesophageal reflux disease (FSSG). The outcome measures for the assessment of treatment efficacy were heartburn, epigastric pain and the Frequency Scale for the Symptoms of gastroesophageal reflux disease score. Safety and quality of life were evaluated in the patients as the secondary outcomes too. RESULTS Seventy-two out of 78 eligible patients completed this trial (35 in the melatonin group and 37 in the placebo group). Heartburn, epigastric pain, and Frequency Scale for the Symptoms of gastroesophageal reflux disease score declined significantly in the melatonin group compared to the placebo group (P = .04, P = .03, and P = .0001, respectively). Moreover, the quality of life score was significantly higher in the melatonin group compared with the placebo group (P = .0001). Adverse events were similarly observed in the 2 groups (P = .55), and there were no serious adverse events. CONCLUSION The combination of sublingual melatonin (3 mg/day) with omeprazole (20 mg/day) may be more effective than omeprazole (20 mg/day) alone in the treatment of gastroesophageal reflux disease.
Collapse
Affiliation(s)
- Habib Malekpour
- Department of Gastroenterology and Hepatology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amin Noori
- Department of Clinical Pharmacy, Shahid Beheshti University of Medical Sciences Faculty of Pharmacy, Tehran, Iran
| | - Saeed Abdi
- Department of Gastroenterology and Hepatology, Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases Ayatollah Taleghani Hospital, Shahid Beheshti University of Medical Sciences Tehran, Iran
| | - Mohammad Abbasinazari
- Department of Clinical Pharmacy, Shahid Beheshti University of Medical Sciences Faculty of Pharmacy, Tehran, Iran
| | - Arash Mahboubi
- Department of Pharmaceutics, Pharmaceutical Sciences Research Center, Shahid Beheshti University of Medical Sciences Faculty of Pharmacy, Tehran, Iran
| | - Mahdiye Abiyar Ghamsari
- Department of Clinical Pharmacy, Shahid Beheshti University of Medical Sciences Faculty of Pharmacy, Tehran, Iran
| |
Collapse
|
8
|
Shaw HA, Remmington A, McKenzie G, Winkel C, Mawas F. Mucosal Immunization Has Benefits over Traditional Subcutaneous Immunization with Group A Streptococcus Antigens in a Pilot Study in a Mouse Model. Vaccines (Basel) 2023; 11:1724. [PMID: 38006056 PMCID: PMC10674289 DOI: 10.3390/vaccines11111724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/18/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Group A Streptococcus (GAS) is a major human pathogen for which there is no licensed vaccine. To protect against infection, a strong systemic and mucosal immune response is likely to be necessary to prevent initial colonization and any events that might lead to invasive disease. A broad immune response will be necessary to target the varied GAS serotypes and disease presentations. To this end, we designed a representative panel of recombinant proteins to cover the stages of GAS infection and investigated whether mucosal and systemic immunity could be stimulated by these protein antigens. We immunized mice sublingually, intranasally and subcutaneously, then measured IgG and IgA antibody levels and functional activity through in vitro assays. Our results show that both sublingual and intranasal immunization in the presence of adjuvant induced both systemic IgG and mucosal IgA. Meanwhile, subcutaneous immunization generated only a serum IgG response. The antibodies mediated binding and killing of GAS cells and blocked binding of GAS to HaCaT cells, particularly following intranasal and subcutaneous immunizations. Further, antigen-specific assays revealed that immune sera inhibited cleavage of IL-8 by SpyCEP and IgG by Mac/IdeS. These results demonstrate that mucosal immunization can induce effective systemic and mucosal antibody responses. This finding warrants further investigation and optimization of humoral and cellular responses as a viable alternative to subcutaneous immunization for urgently needed GAS vaccines.
Collapse
Affiliation(s)
- Helen Alexandra Shaw
- Vaccines Division, Science, Research & Innovation, Medicines and Healthcare Products Regulatory Agency, Potters Bar EN6 3QG, UK
| | | | | | | | | |
Collapse
|
9
|
McDonald MG, Cunning DM. Large Sublingual Lipoma: A Case Report. Ear Nose Throat J 2023:1455613231212058. [PMID: 37970836 DOI: 10.1177/01455613231212058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Lipomas are benign soft tissue tumors frequently observed throughout the body. Lipomas rarely cause health concerns; however, when symptomatic, it is often related to their location and size. A 65-year-old male patient presented with a non-tender, enlarging mass in the anterior floor of the mouth, which was otherwise asymptomatic. Computed tomography evaluation revealed an unusually large hypolucent mass, posterior to the inner table of the right anterior mandible. Surgical excision was uncomplicated. Upon follow-up, the right anterior floor of the mouth wound healed without compromise of the lingual or hypoglossal nerves or Wharton's duct. This discussion highlights the infrequent occurrence of lipomas in the oral cavity, particularly in the floor of the mouth, including patient presentation, preoperative evaluation, and surgical planning.
Collapse
Affiliation(s)
- Mason G McDonald
- Arizona Coast Ear, Nose, & Throat, LTD, Lake Havasu City, AZ, USA
| | - Devin M Cunning
- Arizona Coast Ear, Nose, & Throat, LTD, Lake Havasu City, AZ, USA
| |
Collapse
|
10
|
Kappen J, Diamant Z, Agache I, Bonini M, Bousquet J, Canonica GW, Durham SR, Guibas GV, Hamelmann E, Jutel M, Papadopoulos NG, Roberts G, Shamji MH, Zieglmayer P, Gerth van Wijk R, Pfaar O. Standardization of clinical outcomes used in allergen immunotherapy in allergic asthma: An EAACI position paper. Allergy 2023; 78:2835-2850. [PMID: 37449468 DOI: 10.1111/all.15817] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION In allergic asthma patients, one of the more common phenotypes might benefit from allergen immunotherapy (AIT) as add-on intervention to pharmacological treatment. AIT is a treatment with disease-modifying modalities, the evidence for efficacy is based on controlled clinical trials following standardized endpoint measures. However, so far there is a lack of a consensus for asthma endpoints in AIT trials. The aim of a task force (TF) of the European Academy of Allergy and Clinical Immunology (EAACI) is evaluating several outcome measures for AIT in allergic asthma. METHODS The following domains of outcome measures in asthmatic patients have been evaluated for this position paper (PP): (i) exacerbation rate, (ii) lung function, (iii) ICS withdrawal, (iv) symptoms and rescue medication use, (v) questionnaires (PROMS), (vi) bronchial/nasal provocation, (vii) allergen exposure chambers (AEC) and (viii) biomarkers. RESULTS Exacerbation rate can be used as a reliable objective primary outcome; however, there is limited evidence due to different definitions of exacerbation. The time after ICS withdrawal to first exacerbation is considered a primary outcome measure. Besides, the advantages and disadvantages and clinical implications of further domains of asthma endpoints in AIT trials are elaborated in this PP. CONCLUSION This EAACI-PP aims to highlight important aspects of current asthma measures by critically evaluating their applicability for controlled trials of AIT.
Collapse
Affiliation(s)
- Jasper Kappen
- Department of Pulmonology, STZ Centre of Excellence for Asthma, COPD and Respiratory Allergy, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of National Heart and Lung Institute, Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Imperial College London, London, UK
| | - Zuzana Diamant
- Departmentt of Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium
- Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | | | - Matteo Bonini
- Department of National Heart and Lung Institute, Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Imperial College London, London, UK
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Clinical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Jean Bousquet
- Charite Universitatsmedizin Berlin Campus Berlin Buch, MASK-air, Montpellier, France
| | - G Walter Canonica
- Personalized Medicine Asthma & Allergy Clinic Humanitas University & Research Hospital-IRCCS, Milan, Italy
| | - Stephen R Durham
- Department of National Heart and Lung Institute, Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Imperial College London, London, UK
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - George V Guibas
- Department of Allergy and Clinical Immunology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- School of Biological Sciences, Medicine and Health, University of Manchester, Manchester, UK
| | - Eckard Hamelmann
- Children's Center Bethel, University Hospital Bielefeld, University Bielefeld, Bielefeld, Germany
| | - Marek Jutel
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
- ALL-MED Medical Research Institute, Wroclaw, Poland
| | | | - Graham Roberts
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Paediatric Allergy and Respiratory Medicine (MP803), Clinical & Experimental Sciences & Human Development in Health Academic Units University of Southampton Faculty of Medicine & University Hospital Southampton, Southampton, UK
| | - Mohamed H Shamji
- Department of National Heart and Lung Institute, Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Imperial College London, London, UK
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Petra Zieglmayer
- Karl Landsteiner University, Competence Center for Allergology and Immunology, Krems, Austria
| | - Roy Gerth van Wijk
- Section of Allergology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| |
Collapse
|
11
|
Blaiss M, DuBuske L, Nolte H, Opstrup M, Rance K. A practical guide to prescribing sublingual immunotherapy tablets in North America for pediatric allergic rhinoconjunctivitis: an injection-free allergy immunotherapy option. Front Pediatr 2023; 11:1244146. [PMID: 37859770 PMCID: PMC10582981 DOI: 10.3389/fped.2023.1244146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/12/2023] [Indexed: 10/21/2023] Open
Abstract
Allergic rhinoconjunctivitis (ARC) is a common disease that affects individuals of all ages. Pediatricians may be the first (and only) point of care for children with ARC. Sublingual immunotherapy (SLIT)-tablets are a convenient at-home, injection-free allergy immunotherapy option that can be used for the treatment of ARC. This paper provides a practical guide for pediatricians to aid in prescribing SLIT-tablets to children with ARC in North America. Topics include a summary of the available SLIT-tablets and their efficacy and safety, guidance on when SLIT-tablets are an appropriate option, and how to diagnose ARC and identify culprit allergens. Practical guidance is also provided through a proposed decision tree, a prescribing checklist and prescribing procedures, and suggested follow-up assessments.
Collapse
Affiliation(s)
- Michael Blaiss
- Department of Pediatrics, Medical College of Georgia, Augusta, GA, United States
| | - Lawrence DuBuske
- Department of Medicine, The George Washington University Hospital, Washington, DC, United States
| | | | | | | |
Collapse
|
12
|
Petkus KD, Noritz G, Glader L. Examining the Role of Sublingual Atropine for the Treatment of Sialorrhea in Patients with Neurodevelopmental Disabilities: A Retrospective Review. J Clin Med 2023; 12:5238. [PMID: 37629280 PMCID: PMC10455410 DOI: 10.3390/jcm12165238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Sialorrhea is common in children with neurodevelopmental disabilities (NDD) and is reported in >40% of children with cerebral palsy (CP). It causes a range of complications, including significant respiratory morbidity. This single-center retrospective chart review aims to document sublingual atropine (SLA) utilization to guide further study in establishing its role in secretion management for children with NDD. A chart review was completed for patients with NDD ≤ 22 years of age treated with SLA at a free-standing children's hospital between 1 January 2016 and 1 June 2021. Descriptive statistics were generated to summarize findings. In total, 190 patients were identified, of which 178 met inclusion criteria. The average starting dose for SLA was 1.5 mg/day, or 0.09 mg/kg/day when adjusted for patient weight. Eighty-nine (50%) patients were prescribed SLA first line for secretion management while 85 (48%) patients tried glycopyrrolate prior to SLA. SLA was used after salivary Botox, ablation, and/or surgery in 16 (9%) patients. This study investigates SLA as a potential pharmacologic agent to treat sialorrhea in children with NDD. We identify a range of prescribing patterns regarding dosing, schedule, and place in therapy, highlighting the need for further evidence to support and guide its safe and efficacious use.
Collapse
Affiliation(s)
- Kayla Durkin Petkus
- Division of Complex Care, Nationwide Children’s Hospital, Columbus, OH 43205, USA; (G.N.); (L.G.)
- Department of Pharmacy, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Garey Noritz
- Division of Complex Care, Nationwide Children’s Hospital, Columbus, OH 43205, USA; (G.N.); (L.G.)
| | - Laurie Glader
- Division of Complex Care, Nationwide Children’s Hospital, Columbus, OH 43205, USA; (G.N.); (L.G.)
| |
Collapse
|
13
|
Asad Ullah M, Ahmed A, Hyder SMS, Javed K, Naeem MQ. An Unusual Case of Sublingual Epidermoid Cyst Mimicking Plunging Ranula. Cureus 2023; 15:e42874. [PMID: 37664298 PMCID: PMC10474325 DOI: 10.7759/cureus.42874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
Epidermoid cyst in the oral cavity is uncommon. It is even more rare to see an epidermoid cyst in the sublingual region. We report the case of a 30-year-old male presenting with a swelling in the floor of the mouth extending into the submental and submandibular regions. The midline swelling was painless, soft, and dome-shaped. CT scan contrast revealed the site and extent of swelling. The complete surgical excision of the lesion was performed via a transcervical approach. Histopathology revealed cystic fibrocollagenous tissue covered by squamous epithelium containing some keratin flakes.
Collapse
Affiliation(s)
- Muhammad Asad Ullah
- Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Awais Ahmed
- Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | | | - Khalid Javed
- Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | | |
Collapse
|
14
|
Homes RAP, Giddens F, Francis RS, Hubbard RE, Gordon EH, Midwinter MJ. The sublingual microcirculation and frailty index in chronic kidney disease patients. Microcirculation 2023; 30:e12819. [PMID: 37285445 PMCID: PMC10909441 DOI: 10.1111/micc.12819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/18/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To examine the relationship between sublingual microcirculatory measures and frailty index in those attending a kidney transplant assessment clinic. METHODS Patients recruited had their sublingual microcirculation taken using sidestream dark field videomicroscopy (MicroScan, Micro Vision Medical, Amsterdam, the Netherlands) and their frailty index score using a validated short form via interview. RESULTS A total of 44 patients were recruited with two being excluded due to microcirculatory image quality scores exceeding 10. The frailty index score indicated significant correlations with total vessel density (p < .0001, r = -.56), microvascular flow index (p = .004, r = -.43), portion of perfused vessels (p = .0004, r = -.52), heterogeneity index (p = .015, r = .32), and perfused vessel density (p < .0001, r = -.66). No correlation was shown between the frailty index and age (p = .08, r = .27). CONCLUSIONS There is a relationship between the frailty index and microcirculatory health in those attending a kidney transplant assessment clinic, that is not confounded by age. These findings suggest that the impaired microcirculation may be an underlying cause of frailty.
Collapse
Affiliation(s)
- Ryan A. P. Homes
- School of Biomedical Science, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Fiona Giddens
- Centre for Health Services Research, Faulty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Ross S. Francis
- Department of NephrologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Ruth E. Hubbard
- Centre for Health Services Research, Faulty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Emily H. Gordon
- Centre for Health Services Research, Faulty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Mark J. Midwinter
- School of Biomedical Science, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| |
Collapse
|
15
|
Lopez-Vidal L, Paredes AJ, Palma SD, Real JP. Design and Development of Sublingual Printlets Containing Domperidone Nanocrystals Using 3D Melting Solidification Printing Process (MESO-PP). Pharmaceutics 2023; 15:pharmaceutics15051459. [PMID: 37242699 DOI: 10.3390/pharmaceutics15051459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Domperidone (DOM) is a drug commonly used to treat nausea and vomiting, as well as gastrointestinal disorders. However, its low solubility and extensive metabolism pose significant administration challenges. In this study, we aimed to improve DOM solubility and avoid its metabolism by developing nanocrystals (NC) of DOM through a 3D printing technology-melting solidification printing process (MESO-PP)-to be delivered via a solid dosage form (SDF) that can be administered sublingually. We obtained DOM-NCs using the wet milling process and designed an ultra-rapid release ink (composed of PEG 1500, propylene glycol, sodium starch glycolate, croscarmellose sodium, and sodium citrate) for the 3D printing process. The results demonstrated an increase in the saturation solubility of DOM in both water and simulated saliva without any physicochemical changes in the ink as observed by DSC, TGA, DRX, and FT-IR. The combination of nanotechnology and 3D printing technology enabled us to produce a rapidly disintegrating SDF with an improved drug-release profile. This study demonstrates the potential of developing sublingual dosage forms for drugs with low aqueous solubility using nanotechnology and 3D printing technology, providing a feasible solution to the challenges associated with the administration of drugs with low solubility and extensive metabolism in pharmacology.
Collapse
Affiliation(s)
- Lucía Lopez-Vidal
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA), CONICET, Haya de la Torre y Medina Allemde, Córdoba X5000HUA, Argentina
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la torre y Medina Allende, Córdoba X5000HUA, Argentina
| | - Alejandro J Paredes
- School of Pharmacy, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Santiago Daniel Palma
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA), CONICET, Haya de la Torre y Medina Allemde, Córdoba X5000HUA, Argentina
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la torre y Medina Allende, Córdoba X5000HUA, Argentina
| | - Juan Pablo Real
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA), CONICET, Haya de la Torre y Medina Allemde, Córdoba X5000HUA, Argentina
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la torre y Medina Allende, Córdoba X5000HUA, Argentina
| |
Collapse
|
16
|
Wise SK, Damask C, Greenhawt M, Oppenheimer J, Roland LT, Shaker MS, Wallace DV, Lang DM. A Synopsis of Guidance for Allergic Rhinitis Diagnosis and Management From ICAR 2023. J Allergy Clin Immunol Pract 2023; 11:773-96. [PMID: 36894277 DOI: 10.1016/j.jaip.2023.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 03/09/2023]
Abstract
An updated edition of the International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR) has recently been published. This consensus document, which included the participation of 87 primary authors and 40 additional consultant authors, who critically appraised evidence on 144 individual topics concerning allergic rhinitis, provides guidance for health care providers using the evidence-based review with recommendations (EBRR) methodology. This synopsis highlights topical areas including pathophysiology, epidemiology, disease burden, risk and protective factors, evaluation and diagnosis, aeroallergen avoidance and environmental controls, single and combination pharmacotherapy options, allergen immunotherapy (subcutaneous, sublingual, rush, cluster), pediatric considerations, alternative and emerging therapies, and unmet needs. Based on the EBRR methodology, ICAR:AR includes strong recommendations for the treatment of allergic rhinitis: (1) for the use of newer generation antihistamines compared with first-generation alternatives, intranasal corticosteroid, intranasal saline, combination therapy with intranasal corticosteroid plus intranasal antihistamine for patients not responding to monotherapy, and subcutaneous immunotherapy and sublingual tablet immunotherapy in properly selected patients; (2) against the use of oral decongestant monotherapy and routine use of oral corticosteroids.
Collapse
|
17
|
Faden J, Musselman M, Citrome L. Sublingual dexmedetomidine: repurposing an anesthetic as an anti-agitation agent. Expert Rev Neurother 2023; 23:97-106. [PMID: 36707066 DOI: 10.1080/14737175.2023.2174430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Especially when acutely ill, individuals with schizophrenia and bipolar disorder can present with agitated behavior. The initial approach to agitation management are non-pharmacologic strategies such as verbal de-escalation techniques; however, pharmacologic interventions may be needed. Dexmedetomidine is a selective alpha-2 adrenergic receptor agonist, and a sublingual formulation has been approved in the US for the treatment of agitation associated with schizophrenia and bipolar disorder in adults. AREAS COVERED The authors review the published literature on sublingual dexmedetomidine using the US National Library of Medicine's PubMed.gov resource. Pharmacodynamics, pharmacokinetics, and efficacy and tolerability findings are summarized. The authors also provide a discussion to its potential place in the treatment armamentarium. EXPERT OPINION Sublingual dexmedetomidine is an effective and well-tolerated pharmacologic option for the treatment of agitation associated with schizophrenia and bipolar disorder. The sublingual method of administration allows for a rapid onset of action with treatment effects beginning as early as 20 minutes after administration. Adverse effects include somnolence, hypotension, oral paresthesia, hypoesthesia, and dry mouth. Further study will be needed to evaluate sublingual dexmedetomidine in real-world patients receiving concomitant psychotropic medications.
Collapse
Affiliation(s)
- Justin Faden
- Department of Psychiatry and Behavioral Sciences, Temple University School of Medicine, Philadelphia, PA, United States
| | - Meghan Musselman
- Department of Psychiatry and Behavioral Sciences, Temple University School of Medicine, Philadelphia, PA, United States
| | - Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, New York, NY, United States
| |
Collapse
|
18
|
Rupniak NMJ, Katofiasc MA, Bae J, Thor KB, Marson L. Colorectal and bladder prokinetic activity of [Lys 5, MeLeu 9, Nle 10]-NKA (4-10) after intranasal or sublingual delivery in dogs. Can J Physiol Pharmacol 2023; 101:171-179. [PMID: 36716436 DOI: 10.1139/cjpp-2022-0498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The feasibility of eliciting defecation and urination after intranasal (IN) or sublingual (SL) delivery of a small peptide NK2 receptor agonist, [Lys5, MeLeu9, Nle10]-NKA(4-10), was examined using prototype formulations in dogs. In anesthetized animals, administration of 100 or 300 µg/kg IN or 2.0-6.7 mg/kg SL increased colorectal peak pressure and area under the curve. Peak bladder pressure was also increased at the same doses, and this was accompanied by highly efficient voiding at normal physiological bladder pressure. The onset of these effects was rapid (≤2.5 min), and the primary contractions lasted ∼25 min, returning to baseline in <60 min. Slight hypotension lasting a few minutes and causing <10% change from baseline was detected after higher doses and was statistically significant after only 100 µg/kg IN. In conscious dogs, there was a dose-related increase in voiding responses and reduction in the latency to urinate and defecate after 300 and 1000 µg/kg IN; emesis was also observed at these doses. SL administration of 6.7 mg/kg induced urination within 10 min, but not defecation or emesis. These findings support the feasibility of developing a convenient dosage form of small peptide NK2 receptor agonists as on-demand defecation or urination therapies.
Collapse
Affiliation(s)
- Nadia M J Rupniak
- Dignify Therapeutics LLC, 2 Davis Drive, Research Triangle Park, NC 27709, USA
| | - Mary A Katofiasc
- Dignify Therapeutics LLC, 2 Davis Drive, Research Triangle Park, NC 27709, USA
| | - Jungeun Bae
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC 27599, USA
| | - Karl B Thor
- Dignify Therapeutics LLC, 2 Davis Drive, Research Triangle Park, NC 27709, USA
| | - Lesley Marson
- Dignify Therapeutics LLC, 2 Davis Drive, Research Triangle Park, NC 27709, USA
| |
Collapse
|
19
|
Gu M, Li A, Mak W, Dong F, Xu N, Zhang J, Shi Y, Zheng N, Tang Z, He Q, Ruan C, Guo W, Xiang X, Wang C, Han B, Zhu X. Population pharmacokinetics of buprenorphine and naloxone sublingual combination in Chinese healthy volunteers and patients with opioid use disorder: Model-based dose optimization. Front Pharmacol 2023; 14:1089862. [PMID: 36744255 PMCID: PMC9893638 DOI: 10.3389/fphar.2023.1089862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
The sublingual combination of buprenorphine (BUP) and naloxone (NLX) is a new treatment option for opioid use disorder (OUD) and is effective in preventing drug abuse. This study aimed to explore rational dosing regimen for OUD patients in China via a model-based dose optimization approach. BUP, norbuprenorphine (norBUP), and NLX plasma concentrations of 34 healthy volunteers and 12 OUD subjects after single or repeated dosing were included. A parent-metabolite population pharmacokinetics (popPK) model with transit compartments for absorption was implemented to describe the pharmacokinetic profile of BUP-norBUP. In addition, NLX concentrations were well captured by a one-compartment popPK model. Covariate analysis showed that every additional swallow after the administration within the observed range (0-12) resulted in a 3.5% reduction in BUP bioavailability. This provides a possible reason for the less-than-dose proportionality of BUP. There were no differences in the pharmacokinetic characteristics between BUP or NLX in healthy volunteers and OUD subjects. Ethnic sensitivity analysis demonstrated that the dose-normalized peak concentration and area-under-the-curve of BUP in Chinese were about half of Puerto Ricans, which was consistent with a higher clearance observed in Chinese (166 L / h vs. 270 L / h ). Furthermore, Monte Carlo simulations showed that an 8 mg three-times daily dose was the optimized regimen for Chinese OUD subjects. This regimen ensured that opioid receptor occupancy remained at a maximum (70%) in more than 95% of subjects, at the same time, with NLX plasma concentrations below the withdrawal reaction threshold (4.6 n g / m L ).
Collapse
Affiliation(s)
- Meng Gu
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China,Department of Pharmacy, Minhang Hospital, Fudan University, Shanghai, China
| | - Anning Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Wenyao Mak
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China
| | - Fang Dong
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Nuo Xu
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China
| | - Jingye Zhang
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China
| | - Yufei Shi
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China
| | - Nan Zheng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zhijia Tang
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China
| | - Qingfeng He
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China
| | - Canjun Ruan
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Wei Guo
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xiaoqiang Xiang
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China
| | - Chuanyue Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China,*Correspondence: Xiao Zhu, ; Bing Han, ; Chuanyue Wang,
| | - Bing Han
- Department of Pharmacy, Minhang Hospital, Fudan University, Shanghai, China,*Correspondence: Xiao Zhu, ; Bing Han, ; Chuanyue Wang,
| | - Xiao Zhu
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China,*Correspondence: Xiao Zhu, ; Bing Han, ; Chuanyue Wang,
| |
Collapse
|
20
|
Hasanzarrini M, Nirumandi Jahromi S, Mohammad Salehi A, Ataei S, Seyfi Z, Poorolajal J. Evaluation of the sedative effect of sublingual lorazepam versus placebo in patients underwent endoscopy: a double-blind, randomized controlled clinical trial. Ther Adv Gastrointest Endosc 2023; 16:26317745231219597. [PMID: 38143918 PMCID: PMC10748895 DOI: 10.1177/26317745231219597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/09/2023] [Indexed: 12/26/2023] Open
Abstract
Background Digestive endoscopy (DE) is uncomfortable for most patients. Lorazepam is a potent benzodiazepine with anxiolytic and sedative effects. Objective This study aims to determine the sedative effect of sublingual lorazepam versus placebo as a premedication in patients who underwent DE. Design This is a mono-center, double-blind, and randomized controlled trial. Methods A lorazepam sublingual tablet was made by researchers and physical tests were done on it, then the double-blind placebo-controlled trial was done to investigate the efficacy of 2 mg sublingually administered lorazepam as a premedication for endoscopy. Lorazepam or a placebo tablet was administered sublingually 30 min before the endoscopy. The patients, nurses, and physicians were blinded to the patient group. The depth of sedation was evaluated according to the American Society of Anesthesiology. Results In all, 116 patients were randomly assigned to take either lorazepam (n = 58) or a placebo (n = 58). The results of physical properties tests were acceptable according to United States Pharmacopeia. There were no statistical differences between groups regarding age and gender. In the lorazepam group, 75.8% of patients showed mild sedation, and 24.2% of patients showed no sedation. All of the patients in the placebo had no sedation (p = 0.001). Time of procedure (p < 0.001), intraoperative O2 saturation (p < 0.001), intraoperative heart rate (p < 0.001), and intraoperative blood pressure (p < 0.001) were significantly lower in the lorazepam group. No significant or dangerous side effects were observed except a bit of giddiness and dizziness. Conclusion The results of this study showed that prescription of sublingual lorazepam 25-30 min before endoscopy provided mild sedation. Registration IRCT201611039014N130 (05/11/2016); https://en.irct.ir/trial/9568.
Collapse
Affiliation(s)
- Maryam Hasanzarrini
- Clinical Research Development Unit of Shahid Beheshti Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | - Samira Nirumandi Jahromi
- Clinical Research Development Unit of Shahid Beheshti Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | - Amir Mohammad Salehi
- Student Research Committee, Hamadan University of Medical Sciences, Shahid Fahmideh St, Hamadan 6517838838, Iran
| | - Sara Ataei
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Zohreh Seyfi
- School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jalal Poorolajal
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| |
Collapse
|
21
|
Dokku KS, Nair AS, Mantha SSP, Naik VM, Saifuddin MS, Rayani BK. A randomized controlled study to compare analgesic efficacy of sublingual buprenorphine and intravenous tramadol in patients undergoing mastectomy. Med Gas Res 2022; 13:118-122. [PMID: 36571376 PMCID: PMC9979200 DOI: 10.4103/2045-9912.345170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Sublingual (SL) buprenorphine is approved for managing acute postoperative pain, characterized by easy administration, good pain relief and good patient compliance. We hypothesized that SL buprenorphine would be a better perioperative analgesic compared to intravenous (IV) opioids like tramadol in patients undergoing mastectomy surgery for breast cancer. After institutional ethics committee approval, we randomized 60 patients with breast cancer into 2 groups. In buprenorphine group, patients received 200 μg of SL buprenorphine thrice daily and in tramadol group patients received 100 mg of IV tramadol thrice daily. The analgesic efficacy of SL buprenorphine was comparable to that of IV tramadol. Visual Analogue Scale scores had no significant difference between the two groups at various time frames (0, 1, 3, 6, 12, 18 and 24 hours) at rest and movement except at 0 and 3 hours during movement when the score was lower in the tramadol group than the buprenorphine group. Four patients in the buprenorphine group received rescue analgesic (IV morphine 3 mg). Analgesic efficacy of SL buprenorphine appears comparable to IV tramadol for managing postoperative pain after mastectomy. SL buprenorphine can be administered sublingually, which is an advantage.
Collapse
Affiliation(s)
- Krishna Sumanth Dokku
- Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Abhijit Sukumaran Nair
- Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India,Correspondence to: Abhijit Sukumaran Nair, E-mail:
| | | | - Vibhavari Milind Naik
- Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Mohammed Salman Saifuddin
- Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Basanth Kumar Rayani
- Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| |
Collapse
|
22
|
Gehrt F, Xu Q, Baiardini I, Canonica GW, Pfaar O. Adherence in allergen immunotherapy: Current situation and future implications. Allergol Select 2022; 6:276-284. [PMID: 36457724 PMCID: PMC9707370 DOI: 10.5414/alx02318e] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/03/2022] [Indexed: 09/26/2023] Open
Abstract
Allergen immunotherapy (AIT) is the only disease-modifying treatment in allergy. However clinical trials as well as real-life studies revealed poor treatment adherence. This article is intended to provide an overview of the current literature of the last 10 years, to outline reasons for poor treatment adherence in AIT and to provide possible solutions for improving adherence.
Collapse
Affiliation(s)
- Francesca Gehrt
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
| | - Qingqing Xu
- Department of Allergy, Beijing Tong Ren Hospital, Capital Medical University
- Department of Otolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Capital Medical University, Beijing, PR China
| | - Ilaria Baiardini
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, and
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, and
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
| |
Collapse
|
23
|
Monge C, Ayad C, Paris AL, Rovera R, Colomb E, Verrier B. Mucosal Adjuvants Delivered by a Mucoadhesive Patch for Sublingual Administration of Subunit Vaccines. Int J Mol Sci 2022; 23:13440. [PMID: 36362224 PMCID: PMC9655718 DOI: 10.3390/ijms232113440] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/19/2023] Open
Abstract
Among mucosal administration routes for vaccines, the sublingual route has been proven capable of inducing a potent systemic and mucosal immune response. However, the absence of a simple and compliant delivery system and the lack of robust mucosal adjuvants impede the development of sublingual vaccines. Here, we describe a mucoadhesive patch made of a layer-by-layer assembly of polysaccharides, chitosan, and hyaluronic acid. The mucoadhesive patch was covered by adjuvanted nanoparticles carrying viral proteins. We showed that the nanoparticles effectively cross the outer layers of the sublingual mucosa to reach the epithelium. Furthermore, the encapsulated adjuvants, 3M-052 and mifamurtide, targeting toll-like receptor (TLR) 7/8 and nucleotide-binding oligomerization domain-2 (NOD2), respectively, remain fully active after encapsulation into nanoparticles and exhibit a cytokine/chemokine signature similar to the mucosal gold-standard adjuvant, the cholera toxin. However, the particulate adjuvants induced more moderate levels of proinflammatory interleukin (IL)-6 and keratinocyte chemoattractant (KC), suggesting a controlled activation of the innate immune response.
Collapse
Affiliation(s)
- Claire Monge
- UMR 5305: Laboratoire de Biologie Tissulaire et d’Ingénierie Thérapeutique, Institut de Biologie et Chimie des Protéines, CNRS/Université Claude Bernard Lyon 1, 7 Passage du Vercors, 69007 Lyon, France
| | | | | | | | | | | |
Collapse
|
24
|
Steenkamp G, Tordiffe ASW, Suleman E, Oosthuizen A, Brettschneider H, Boy SC. Sublingual papillomas of cheetahs in southern Africa. Vet Pathol 2022; 59:997-1002. [PMID: 35815910 DOI: 10.1177/03009858221109610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nine distinct papillomaviruses (Lambdapapillomavirus) have been described in domestic and nondomestic cats, but not in cheetahs. These viruses have been associated with cutaneous papillomas or plaques, bowenoid in situ carcinomas, feline cutaneous squamous cell carcinomas (SCC), feline sarcoids, and oral (often sublingual) papillomas. Fourteen cheetahs from the AfriCat foundation (Namibia) and one from the Ann van Dyk Cheetah center (South Africa) presented with sublingual lesions reminiscent of sublingual papillomas. Two animals were biopsied and the histopathology revealed benign proliferative epithelial lesions with prominent thickening of the overlying squamous epithelium. Throughout the squamous epithelial layers were cells with nuclear enlargement, irregularity of the nuclear membranes and cell contours, focal hyperchromasia of the nuclei, and perinuclear halos, reminiscent of a virus-associated process as seen in papillomavirus infections. Thirteen more cheetahs were sampled and the tissue snap frozen for molecular characterization. Amplification and sequencing of the papillomavirus L1, E6, E7, and E1 gene regions was achieved with modified primers. Maximum likelihood phylogenetic analyses revealed all 15 cheetah papilloma samples were 99.99% genetically similar and closely related to, but genetically distinct from any known felinepapillomaviruses. All cheetahs were FIV and FeLV negative. The results suggest the samples identified in this study can be considered a previously undescribed or novel feline papillomavirus and the authors propose "Acinonyx jubatus papillomavirus type 1" (AjPV-1), within the Lambdapapillomavirus 1 genus (Family: Papillomaviridae).
Collapse
Affiliation(s)
- Gerhard Steenkamp
- University of Pretoria, Pretoria, South Africa.,University of Pretoria, Gauteng, South Africa
| | | | - Essa Suleman
- South African National Biodiversity Institute, Pretoria, South Africa.,Council for Scientific and Industrial Research, Pretoria, South Africa
| | - Almero Oosthuizen
- South African National Biodiversity Institute, Pretoria, South Africa.,ZooOmics™-Inqaba Biotec, Pretoria, South Africa
| | | | - Sonja C Boy
- Sefako Makgatho Health Sciences University, Gar-Rankuwa, South Africa.,Lancet Laboratories, Pretoria, South Africa
| |
Collapse
|
25
|
Hassan K, Struthers WM, Sankarabhotla A, Davis P. Safety, effectiveness and tolerability of sublingual ketamine in depression and anxiety: A retrospective study of off-label, at-home use. Front Psychiatry 2022; 13:992624. [PMID: 36245861 PMCID: PMC9554222 DOI: 10.3389/fpsyt.2022.992624] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Intravenous and intranasal ketamine have been shown to be effective therapeutic options in patients suffering from treatment-resistant depression (TRD). The use of sublingual (SL), rapid dissolve ketamine tablets (RDT) offers a novel approach for delivery for mental health indications. This study assessed the effectiveness and safety of self-administration of off-label, SL, rapid dissolve ketamine tablets (RDT) at-home for depression and anxiety. Intake scores on the Generalized Anxiety Disorder Screener (GAD-7) and Patient Health Questionnaire (PHQ-9) were compared to scores after treatments of three doses of ketamine RDT, and after six doses of ketamine RDT. After three doses of SL ketamine, 47.6% of patients showed a significant decrease in PHQ-9 scores, and 47.6% of patients showed a significant reduction in GAD-7 scores. Reduction rates were higher in those patients who completed a clinically recommended six doses of RDT ketamine. This study demonstrates that SL ketamine is a novel, safe, and effective treatment for TRD and treatment-resistant anxiety. SL ketamine offers an alternative therapeutic approach to IV ketamine when treating those with TRD.
Collapse
|
26
|
Chubbs B, Wang J, Archer S, Chrenek C, Khullar A, Wolowyk M, Swainson J. A survey of drug liking and cravings in patients using sublingual or intranasal ketamine for treatment resistant depression: A preliminary evaluation of real world addictive potential. Front Psychiatry 2022; 13:1016439. [PMID: 36465297 PMCID: PMC9714431 DOI: 10.3389/fpsyt.2022.1016439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
Ketamine has gained rapid popularity as a treatment option for treatment resistant depression (TRD). Though seen only in limited contexts, ketamine is a potential drug of abuse, addiction and diversion. Clinical ketamine studies to date have not systematically evaluated factors relevant to addiction risk in patients with TRD, but in treating patients with ketamine, risks of potential harms related to addiction must be considered. As clinical access to intravenous ketamine programs is limited in much of Canada, these considerations become even more important for clinicians who elect to offer patients less supervised, non-parenteral forms of ketamine treatment. This study explores factors relevant to addiction risk in a real-world sample of 33 patients with TRD currently or previously treated with sublingual (SL) or intranasal (IN) ketamine in the community. First, patients were surveyed using a Drug Liking and Craving Questionnaire (DLCQ) to assess their level of drug liking and craving for ketamine, and to screen for symptoms of a ketamine use disorder. Second, the pharmacy records of these patients were reviewed for red flags for addiction such as dose escalation or early refills. Third, surveys were administered to the treating psychiatrists of patients who had discontinued ketamine to determine if abuse concerns contributed to reason for discontinuation. Though limited to a small sample, results indicate that ketamine is not a universally liked or craved substance in patients with TRD. Prescribers of non-parenteral ketamine should monitor patients and prescribe cautiously. Factors related to addiction (as in the DLCQ) should be explored for clinicians to consider individual risk/benefit for judicious use of ketamine in patients with TRD.
Collapse
Affiliation(s)
- Brittany Chubbs
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Jay Wang
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Shaina Archer
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Carson Chrenek
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Atul Khullar
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | | | - Jennifer Swainson
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
27
|
Orhan Kiliç B, Kiliç S, Şahin Eroğlu E, Gül E, Belen Apak FB. Sublingual methylcobalamin treatment is as effective as intramuscular and peroral cyanocobalamin in children age 0-3 years. Hematology 2021; 26:1013-1017. [PMID: 34871525 DOI: 10.1080/16078454.2021.2010877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Vitamin B12 deficiency is a cause of preventable growth and developmental retardation in children. In this respect, alternative methods such as oral and sublingual treatments are being tried. We aimed to compare the efficacy of oral, sublingual, and intramuscular vitamin B12 treatments in children aged 0-3 years. METHODS The study included 158 patients with serum vitamin B12 deficiency (serum vitamin B12 level <300 ng/L) aged 0-3 years retrospectively. According to the vitamin B12 treatment modalities, the patients were divided into three groups as oral cyanocobalamin (group 1), sublingual methylcobalamin (group 2), and intramuscular cyanocobalamin (group 3). RESULTS The mean values of vitamin B12 levels increased to above 300 ng/L in all three groups. This increase was statistically significant for Group 1,2 and 3 (p<0.05). CONCLUSION Sublingual methylcobalamin was determined as effective as oral and intramuscular cyanocobalamin improving vitamin B12 levels aged 0-3 years. What's already known about this topic?It is already known that intramuscular and oral cyanocobalamin treatments are effective in vitamin B12 deficiency of children.What does this article add?Sublingual methylcobalamin treatment, which is a new treatment method, was found to be as effective as oral and intramuscular cyanocobalamin treatments. To our knowledge, there is no study about sublingual treatment in children and comparing oral cyanocobalamin, intramuscular cyanocobalamin, sublingual methylcobalamin.
Collapse
Affiliation(s)
- Betül Orhan Kiliç
- Department of Pediatrics, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Serhat Kiliç
- Department of Pediatrics, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Elif Şahin Eroğlu
- Department of Pediatrics, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Eylem Gül
- Department of Biostatistics, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Fatma Burcu Belen Apak
- Department of Pediatric Hematology, Baskent University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
28
|
Doll E, Gunsolus I, Thorgerson A, Tangpricha V, Lamberton N, Sarvaideo JL. Pharmacokinetics of Sublingual vs. Oral Estradiol in Transgender Women. Endocr Pract 2021; 28:237-242. [PMID: 34781041 DOI: 10.1016/j.eprac.2021.11.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/25/2021] [Accepted: 11/04/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the pharmacokinetics of 17ß-estradiol administered orally versus sublingually in transgender women. METHODS Single doses of 17ß-estradiol were administered orally (1 mg) to ten transgender women, then sublingually (1 mg) after a one-week washout. Blood samples were taken at baseline and T = 1,2,3,4,6,8 hours after dosing. Samples were frozen and analyzed using LC-MS/MS (liquid chromatography mass spectrometry) and immunoassay. RESULTS Results demonstrated that sublingual estradiol had a significantly higher peak serum estradiol (E2) concentration at 144 pg/mL by LC-MS/MS compared to oral estradiol at 35 pg/mL by LC-MS/MS (p= 0.003). Sublingual estradiol peaked at hour 1 and oral estradiol peaked at hour 8 when measured by LC-MS/MS. The area under the curve (AUC) 0-8h for sublingual estradiol measured by LC-MS/MS showed a 1.8-fold higher level compared to the AUC 0-8h for oral estradiol measured by LC-MS/MS. Additionally, sublingual E2 was found to have an increased E2 to estrone (E1) ratio at all timepoints (1.1 ± 1.0 v. 0.7 ± 0.4, p= <0.0001), the clinical significance of which is unclear. CONCLUSION Oral estradiol administered sublingually has a different pharmacokinetic profile, with higher serum estradiol levels and AUC (0-8h) than traditionally administered oral E2. Multi-daily dosing may be necessary to suppress testosterone levels with sublingual estradiol. The appropriate dosing, efficacy and safety of sublingual estradiol compared to other estradiol preparations is unknown.
Collapse
Affiliation(s)
| | - Ian Gunsolus
- Medical College of Wisconsin, Department of Pathology
| | | | - Vin Tangpricha
- Emory University School of Medicine, Division of Endocrinology
| | - Nathan Lamberton
- Medical College of Wisconsin School of Pharmacy, Department of Clinical Sciences
| | - Jenna L Sarvaideo
- Medical College of Wisconsin, Division of Endocrinology and Molecular Medicine.
| |
Collapse
|
29
|
Latysheva E, Nazarova E, Latysheva T, Ilina N. Case Report: Safe and Effective Sublingual Birch Allergen Immunotherapy in Two HIV-Positive Patients. Front Immunol 2021; 12:599955. [PMID: 34385997 PMCID: PMC8354585 DOI: 10.3389/fimmu.2021.599955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 07/01/2021] [Indexed: 11/13/2022] Open
Abstract
Allergen-specific immunotherapy (AIT) is a safe, effective treatment for respiratory allergies (such as moderate-to-severe allergic rhinoconjunctivitis) that are not controlled by symptomatic medications. The indications and contraindications for AIT have been defined in international guidelines and consensus statements. However, some of these contraindications are not evidenced- based but have been deduced from the theoretical risk of an interaction between AIT disease-modifying effect and immune or inflammatory comorbidities. In the absence of clinical trial evidence, the accumulation of experience as case reports can narrow the spectrum of absolute contraindications. The majority of international guidelines list HIV infection as a contraindication to AIT. Here, we describe two cases of safe, effective sublingual birch pollen AIT in HIV-positive patients undergoing concomitant antiretroviral therapy. A 32-year-old female and a 63-year-old male sensitized to tree pollen and with clinically confirmed birch pollen allergy underwent pre- and co-seasonal sublingual birch pollen AIT for three and two pollen seasons, respectively. The therapy was associated with a marked reduction in the frequency and intensity of allergic symptoms, and the reduced use of (symptomatic) rescue medication. Mild, local, treatment-emergent adverse events were noted throughout the course of treatment but resolved spontaneously. No serious adverse events were reported. In particular, there were no obvious harmful effects on the patients' immune status or viral load. Hence, sublingual birch pollen AIT proved to be effective and safe in two HIV-positive patients.
Collapse
Affiliation(s)
- Elena Latysheva
- Institute of Immunology, National Research Center Institute of Immunology Federal Biomedical Agency, Moscow, Russia
| | | | | | | |
Collapse
|
30
|
Abstract
Topical minoxidil (5% foam, 5% solution, and 2% solution) is FDA-approved for androgenetic alopecia (AGA) in men and women.Mechanism of action: Minoxidil acts through multiple pathways (vasodilator, anti-inflammatory agent, inducer of the Wnt/β-catenin signaling pathway, an antiandrogen), and may also affect the length of the anagen and telogen phases.Pharmacokinetics: Approximately 1.4% of topical minoxidil is absorbed through the skin. Minoxidil is a prodrug that is metabolized by follicular sulfotransferase to minoxidil sulfate (active form). Those with higher sulfotransferase activity may respond better than patients with lower sulfotransferase activity.Clinical efficacy (topical minoxidil): In a five-year study, 2% minoxidil exhibited peak hair growth in males at year one with a decline in subsequent years. Topical minoxidil causes hair regrowth in both frontotemporal and vertex areas. The 5% solution and foam were not significantly different in efficacy from the 2% solution.Oral and Sublingual minoxidil (not FDA approved; off-label): After 6 months of administration, minoxidil 5 mg/day was significantly more effective than topical 5% and 2% in male AGA. Low-dose 0.5-5 mg/day may also be safe and effective for female pattern hair loss and chronic telogen effluvium. Sublingual minoxidil may be safe and effective in male and female pattern hair loss.
Collapse
Affiliation(s)
- A K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada.,Mediprobe Research Inc., London, Canada
| | | | | | | |
Collapse
|
31
|
Naguib MJ, Makhlouf AIA. Scalable flibanserin nanocrystal-based novel sublingual platform for female hypoactive sexual desire disorder: engineering, optimization adopting the desirability function approach and in vivo pharmacokinetic study. Drug Deliv 2021; 28:1301-1311. [PMID: 34176378 PMCID: PMC8238064 DOI: 10.1080/10717544.2021.1938755] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Flibanserin (FLB) was approved by FDA for the treatment of pre-menopausal female hypoactive sexual desire disorder (HSDD). FLB suffers from low oral bioavailability (33%) which might be due to hepatic first-pass metabolism in addition to its poor aqueous solubility. The sublingual route could be a promising alternative for FLB due to the avoidance of enterohepatic circulation. However, the drug needs to dissolve in the small volume of saliva in order to be absorbed through the sublingual mucosa. Therefore, FLB nanocrystals were prepared by sono-precipitation technique according to 23 full factorial design. FLB-nanocrystals were formulated using two surfactants (PVP K30 and PL F127) in two different amounts (200 and 400 mg) and the volume of ethanol was either 3 or 5 mL. Nanocrystal formulation was optimized according to the desirability function to have a minimum particle size, zeta potential, polydispersity index, and maximum saturated solubility. The optimized formula had a particle size of 443.12 ± 14.91 nm and a saturated solubility of 23.27 ± 4.62 mg/L which is five times the saturated solubility of FLB. Nanocrystal dispersion of the optimized formula was solidified by freeze-drying and used to prepare rapidly disintegrating sublingual tablets containing Pharmaburst® as superdisintegrant. Sublingual tablet formulation with the shortest disintegration time (36 s) was selected for the in vivo study. FLB nanocrystal-based sublingual tablets exhibited a two-fold increase in bioavailability with a faster onset of action compared to the commercially available oral formulation. These findings prove the potential application of FLB nanocrystal-based sublingual tablets in the treatment of HSDD.
Collapse
Affiliation(s)
- Marianne J Naguib
- Faculty of Pharmacy, Department of Pharmaceutics and Industrial Pharmacy, Cairo University, Cairo, Egypt
| | - Amal I A Makhlouf
- Faculty of Pharmacy, Department of Pharmaceutics and Industrial Pharmacy, Cairo University, Cairo, Egypt
| |
Collapse
|
32
|
Plaza V, Arnedillo A, Blanco-Aparicio M, Ignacio JM, Urrutia I. Consensus on the treatment of allergic asthma with sublingual house dust mite immunotherapy in the field of Pneumology. Expert Rev Respir Med 2021; 15:1245-1249. [PMID: 34128758 DOI: 10.1080/17476348.2021.1942846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION : Many patients sensitized to mites remain symptomatic and uncontrolled despite traditional treatment. Sublingual immunotherapy (SLIT) has demonstrated to reduce the symptoms of allergic rhinitis, the need for additional drug treatments, and to reduce the number of moderate and severe exacerbations in patients with allergic asthma caused by mites that had not been adequately controlled. AREAS COVERED : After reviewing the most recent literature, a scientific committee composed by 5 pneumologists experts in asthma proposed 41 items that addressed the diagnosis of allergic asthma caused by mites, the role of house dust mite (HDM) SLIT tablet in the therapeutic plan and in the control of the disease, and the profile of patients with asthma candidates for this therapy. Through a modified Delphi method, the items were send to 106 pneumologists involved in asthma to be agreed. EXPERT OPINION : The high degree of consensus reached by the panel of pneumologists shows the importance of HDM SLIT tablet in the treatment of allergic asthma caused by mites, particularly taking into account that they barely use this therapy because until now they did not have a registered treatment with solid evidence of efficacy and safety.
Collapse
Affiliation(s)
- Vicente Plaza
- Director del Comité Ejecutivo de la Guía Española para el Manejo del Asma (GEMA). Servei de Pneumologia i Al·lèrgia. Hospital de la Santa Creu i Sant Pau. Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau). Universitat Autònoma de Barcelona. Barcelona, Spain
| | - Aurelio Arnedillo
- UGC de Neumología, Alergia y Cirugía torácica. Hospital Universitario Puerta del Mar. Cádiz, Spain
| | - Marina Blanco-Aparicio
- Coordinadora del Área de Asma de SEPAR. Servicio de Neumología. Complejo Hospitalario Universitario A Coruña. A Coruña. Spain
| | - José María Ignacio
- Servicio de Neumología. Hospital Quirónsalud Marbella. Marbella, Málaga, Spain
| | - Isabel Urrutia
- Unidad de Asma. Hospital Universitario de Galdakao. Galdakao, Bizkaia, Spain.
| |
Collapse
|
33
|
Stankiewicz J, Jeyaraju M, Maheshwari S, Deitchman AR, McCurdy MT. Sublingual Microcirculatory Characteristics of a Case of Profound Chemotherapy-Induced Anemia Treated With a Hemoglobin-Based Oxygen Carrier. Cureus 2021; 13:e15048. [PMID: 34150399 PMCID: PMC8203304 DOI: 10.7759/cureus.15048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Handheld vital microscopy (HVM) can deepen our understanding of hematologic diseases and therapeutics. However, limited reports have assessed human microcirculation during profound anemia, and response to hemoglobin-based oxygen carriers (HBOCs). A 58-year-old woman presented with constitutional symptoms and was diagnosed with acute myeloblastic leukemia. Subsequently, the patient clinically decompensated and was found to have a hemoglobin of 1.9 g/dL. Human blood product administration was not consistent with her beliefs, and she received supportive care with HBOC-201. Concomitantly, her sublingual microcirculation revealed a markedly low microvascular flow index (2.59±0.26), proportion perfused vessels (66.8±18.8%), perfused vessel density (4.41±0.56 mm/mm2), and total vessel density (6.93±1.91 mm/mm2). HVM imaging is a promising point-of-care device for various hematologic conditions, with the potential to understand tissue-level perfusion in novel clinical scenarios, including profound anemia and HBOC administration, as illustrated in this case report.
Collapse
Affiliation(s)
- Jason Stankiewicz
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, USA
| | - Maniraj Jeyaraju
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, USA
| | - Sanjay Maheshwari
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, USA
| | | | - Michael T McCurdy
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, USA
| |
Collapse
|
34
|
Targhotra M, Chauhan MK. An Overview on Various Approaches and Recent Patents on Buccal Drug Delivery Systems. Curr Pharm Des 2021; 26:5030-5039. [PMID: 32534560 DOI: 10.2174/1381612826666200614182013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/13/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Buccal delivery is an alluring course of organization for fundamental medication conveyance and it leads direct access to the systemic flow through the interior jugular vein sidesteps drugs from the hepatic first-pass digestion gives high bioavailability. OBJECTIVE This article aims at buccal medication conveyance by discussing the structure and condition of the oral mucosa and the novel strategies utilized in evaluating buccal medication ingestion. METHODS This review highlights the various pharmaceutical approaches for buccal delivery such as buccal tablets, buccal lozenges, buccal micro/nanoparticle, wafer and semisolid dosage forms like chewing gums, buccal patch, buccal gel or ointment and some buccal liquid dosage forms like buccal solutions and buccal sprays and recent patents filed or granted for these approaches. RESULTS Recently, some patents are also reported where a combination of various approaches is being employed to achieve very effective mucosal delivery. The various patent search sites were used to collect and analyze the information on buccal drug delivery systems. CONCLUSION The present study provides valuable information, advantages, limitations and future outlook of various buccal drug delivery systems.
Collapse
Affiliation(s)
- Monika Targhotra
- NDDS Research Laboratory, Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, DPSRUniversity, Pushp Vihar, Sec 3, New Delhi, 110017, India
| | - Meenakshi K Chauhan
- NDDS Research Laboratory, Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, DPSRUniversity, Pushp Vihar, Sec 3, New Delhi, 110017, India
| |
Collapse
|
35
|
Favaron E, Ince C, Hilty MP, Ergin B, van der Zee P, Uz Z, Wendel Garcia PD, Hofmaenner DA, Acevedo CT, van Boven WJ, Akin S, Gommers D, Endeman H. Capillary Leukocytes, Microaggregates, and the Response to Hypoxemia in the Microcirculation of Coronavirus Disease 2019 Patients. Crit Care Med 2021; 49:661-670. [PMID: 33405410 PMCID: PMC7963442 DOI: 10.1097/ccm.0000000000004862] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES In this study, we hypothesized that coronavirus disease 2019 patients exhibit sublingual microcirculatory alterations caused by inflammation, coagulopathy, and hypoxemia. DESIGN Multicenter case-controlled study. SETTING Two ICUs in The Netherlands and one in Switzerland. PATIENTS Thirty-four critically ill coronavirus disease 2019 patients were compared with 33 healthy volunteers. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The microcirculatory parameters quantified included total vessel density (mm × mm-2), functional capillary density (mm × mm-2), proportion of perfused vessels (%), capillary hematocrit (%), the ratio of capillary hematocrit to systemic hematocrit, and capillary RBC velocity (μm × s-1). The number of leukocytes in capillary-postcapillary venule units per 4-second image sequence (4 s-1) and capillary RBC microaggregates (4 s-1) was measured. In comparison with healthy volunteers, the microcirculation of coronavirus disease 2019 patients showed increases in total vessel density (22.8 ± sd 5.1 vs 19.9 ± 3.3; p < 0.0001) and functional capillary density (22.2 ± 4.8 vs 18.8 ± 3.1; p < 0.002), proportion of perfused vessel (97.6 ± 2.1 vs 94.6 ± 6.5; p < 0.01), RBC velocity (362 ± 48 vs 306 ± 53; p < 0.0001), capillary hematocrit (5.3 ± 1.3 vs 4.7 ± 0.8; p < 0.01), and capillary-hematocrit-to-systemic-hematocrit ratio (0.18 ± 0.0 vs 0.11 ± 0.0; p < 0.0001). These effects were present in coronavirus disease 2019 patients with Sequential Organ Failure Assessment scores less than 10 but not in patients with Sequential Organ Failure Assessment scores greater than or equal to 10. The numbers of leukocytes (17.6 ± 6.7 vs 5.2 ± 2.3; p < 0.0001) and RBC microaggregates (0.90 ± 1.12 vs 0.06 ± 0.24; p < 0.0001) was higher in the microcirculation of the coronavirus disease 2019 patients. Receiver-operating-characteristics analysis of the microcirculatory parameters identified the number of microcirculatory leukocytes and the capillary-hematocrit-to-systemic-hematocrit ratio as the most sensitive parameters distinguishing coronavirus disease 2019 patients from healthy volunteers. CONCLUSIONS The response of the microcirculation to coronavirus disease 2019-induced hypoxemia seems to be to increase its oxygen-extraction capacity by increasing RBC availability. Inflammation and hypercoagulation are apparent in the microcirculation by increased numbers of leukocytes and RBC microaggregates.
Collapse
Affiliation(s)
- Emanuele Favaron
- Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Can Ince
- Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Matthias P Hilty
- Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zürich, Switzerland
| | - Bülent Ergin
- Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Philip van der Zee
- Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Zühre Uz
- Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Pedro D Wendel Garcia
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zürich, Switzerland
| | - Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zürich, Switzerland
| | - Claudio T Acevedo
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zürich, Switzerland
| | - Wim Jan van Boven
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Sakir Akin
- Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Intensive Care, Haga Hospital, The Hague, The Netherlands
| | - Diederik Gommers
- Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Henrik Endeman
- Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
36
|
Emeryk A, Vallet T, Wawryk-Gawda E, Jędrzejewski A, Durmont F, Ruiz F. Acceptability of a Sublingual Drug Formulation for Respiratory Tract Infections in Children Aged 3 to 5 Years. Pharmaceutics 2021; 13:294. [PMID: 33672395 DOI: 10.3390/pharmaceutics13020294] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022] Open
Abstract
In pediatrics, acceptability has emerged as a key factor for compliance, and consequently for treatment safety and efficacy. Polyvalent mechanical bacterial lysate (PMBL) in 50-mg sublingual tablets is indicated in children and adults for the prophylaxis of recurrent respiratory tract infections. This medication may be prescribed in children over 3 years of age; the appropriateness of this sublingual formulation should thus be demonstrated amongst young children. Using a multivariate approach integrating the many aspects of acceptability, standardized observer reports were collected for medication intake over the course of treatment (days 1, 2, and 10) in 37 patients aged 3 to 5 years, and then analyzed in an intelligible model: the acceptability reference framework. According to this multidimensional model, 50-mg PMBL sublingual tablets were classified as "positively accepted" in children aged 3 to 5 years on all three days of evaluation. As the acceptability evaluation should be relative, we demonstrated that there was no significant difference between the acceptability of these sublingual tablets and a score reflecting the average acceptability of oral/buccal medicines in preschoolers. These results highlight that sublingual formulations could be appropriate for use in preschoolers.
Collapse
|
37
|
Salatin S, Asadi R, Jelvehgari M. Development and characterization of sublingual films for enhanced bioavailability of selegiline hydrochloride. Ther Deliv 2021; 12:159-74. [PMID: 33557601 DOI: 10.4155/tde-2020-0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Low oral bioavailability of selegiline hydrochloride (SH) is primarily due to extensive first-pass metabolism and hence the need for an alternative pathway of administration. Herein, we report the development of sublingual SH films. The films were formulated with varying polymer composition (F1-F6) and evaluated for physicochemical characteristics, in vitro drug release and ex vivo permeation studies. The film F2 demonstrated satisfactory weight (10.60 mg), folding endurance (>200), drug content (11.44 mg/cm2), disintegration time (68 s), mucoadhesive strength (47.7 N/cm2), and controlled release for 30 min. The permeation studies exhibited a higher ex vivo sublingual flux than that of the plain drug. This study concludes that the SH film can provide a potential opportunity for sublingual drug delivery.
Collapse
|
38
|
Cavaliere C, Incorvaia C, Begvarfaj E, Orlando MP, Turchetta R, Musacchio A, Ralli M, Ciofalo A, Greco A, de Vincentiis M, Masieri S. The safety of sublingual immunotherapy, can the rare systemic reactions be prevented? Expert Opin Drug Saf 2021; 20:259-264. [PMID: 33427529 DOI: 10.1080/14740338.2021.1874917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: The safety of subcutaneous immunotherapy (SCIT), and particularly the dramatic issue of fatal reactions, has been an obstacle that limited the implementation of a therapy with unique characteristics of action on the causes of allergy. The introduction of sublingual immunotherapy (SLIT) was aimed at solving safety problems while maintaining clinical efficacy.Areas covered: For more than 20 years, SLIT has been based on allergen extracts in drops at low average doses. As evidenced by meta-analyses, the typical adverse events (AE) have consisted of local reactions in the mouth and throat. Unlike the injection route, no correlation was observed between the administered dose and AEs. The development of SLIT products in tablets, based on higher doses than drops, has somewhat changed the concept of SLIT safety. Although large trials, performed to obtain regulatory agency approval, have shown overall high safety, rare anaphylactic reactions have been described.Expert opinion: SLIT is globally safe, and no fatal reactions have ever been reported, but with currently available high biological potency products it is necessary to follow prudential rules, such as the administration of the first dose under medical supervision and the thorough education of patients to avoid taking of higher doses than recommended.
Collapse
Affiliation(s)
- Carlo Cavaliere
- Department of Oral and Maxillo-Facial Sciences, Sapienza University, Rome, Italy
| | | | - Elona Begvarfaj
- Integrated Activity Head Neck Department, Federico II University, Naples, Italy
| | | | | | | | - Massimo Ralli
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Andrea Ciofalo
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillo-Facial Sciences, Sapienza University, Rome, Italy
| | | |
Collapse
|
39
|
Abstract
Asenapine is a second-generation (atypical) antipsychotic medication not available in a pill that can be swallowed; rather, it is commercialized in sublingual and transdermal formulations. This is a consequence of extensive first-pass metabolism if ingested. The sublingual formulation is approved in many jurisdictions for the treatment of schizophrenia and manic or mixed episodes associated with bipolar I disorder and is available generically. The efficacy profile is well characterized in a number of clinical trials, including an off-label use for the management of agitation. Obstacles to its use include food and drink restrictions, twice-daily dosing and adverse effects such as dysgeusia (distorted, altered, or unpleasant taste) and oral hypoesthesia (numbness). Transdermal asenapine was approved by the US Food and Drug Administration in 2019 for the treatment of schizophrenia in adults. Efficacy was established in a registrational study examining acutely ill inpatients with schizophrenia. The patch needs to changed once daily. Obstacles to its use include the potential for skin reactions such as erythema and pruritis, and being a branded product, it is more costly than other options. This is a narrative review of the chemistry and pharmacokinetics/pharmacodynamics of asenapine, as well as summarizing the efficacy and tolerability of both sublingual and transdermal asenapine, and its possible place in treatment.
Collapse
Affiliation(s)
- Meghan Musselman
- Lewis Katz School of Medicine, Temple University, 100 E. Lehigh Avenue, Suite 305B, Philadelphia, PA 19125, USA
| | - Justin Faden
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | | |
Collapse
|
40
|
Oiwa K, Okafuji I, Tanaka Y, Ito T, Lee S, Okudate D, Tsuruta S. [NEED FOR SUBCUTANEOUS IMMUNOTHERAPY IN PEDIATRIC PATIENTS WITH ALLERGIC RHINITIS AFTER THE EXPANDED INDICATION FOR SUBLINGUAL IMMUNOTHERAPY]. Arerugi 2021; 70:1200-1206. [PMID: 34759085 DOI: 10.15036/arerugi.70.1200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Although the indication for sublingual immunotherapy (SLIT) was expanded in pediatric patients with allergic rhinitis in recent years, some patients choose subcutaneous immunotherapy (SCIT). OBJECTIVE The objective of this study was to investigate the reason why they chose SCIT in spite of injection pain and high risk of systemic reaction. METHODS The subjects were 58 patients who diagnosed with allergic rhinitis and introduced SCIT at our hospital between June 2018 and January 2021. The reasons why they chose SCIT were collected from medical records. RESULT The median age at the start of treatment was 9 years 0 months. The most common reason why they chose SCIT was "difficult to maintain adherence of SLIT" in 28 cases (48%). Other reasons were as follows: "side effects of SLIT", "expectation for the effect of SCIT", "young age (under 5 years old)" and "motivation for allergic disease treatment". CONCLUSION Two-thirds of the reasons why they chose SCIT were because it was difficult to continue SLIT for some reasons.
Collapse
Affiliation(s)
- Kaori Oiwa
- Department of Pediatrics, Kobe City Medical Center General Hospital
| | - Ikuo Okafuji
- Department of Pediatrics, Kobe City Medical Center General Hospital
| | - Yuya Tanaka
- Department of Allergy, Kobe Children's Hospital
| | - Tamaki Ito
- Department of Pediatrics, Kobe City Medical Center General Hospital
| | - Soongji Lee
- Department of Pediatrics, Kobe City Medical Center General Hospital
| | - Daiki Okudate
- Department of Pediatrics, Kobe City Medical Center General Hospital
| | - Satoru Tsuruta
- Department of Pediatrics, Kobe City Medical Center General Hospital
| |
Collapse
|
41
|
Smith JC, Hamilton BK, VanDyke SA. Patient Comfort During Cataract Surgery: A Comparison of Troche and Intravenous Sedation. AANA J 2020; 88:429-435. [PMID: 33218376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Advancements in ophthalmologic procedures warrant exploration of alternative approaches to standard intravenous (IV) anesthesia sedation. One new approach, a sublingual troche containing midazolam, ketamine, and ondansetron, allows for IV catheter-free administration of sedation. This project compared the effectiveness and equivalency of sublingual troche during monitored anesthesia sedation with traditional IV sedation for maintaining comfort in patients undergoing cataract surgery. The study was conducted at a surgery center using an after-only nonequivalent control group design. Patients (N=107) were 55 to 85 years of age; 54 patients received IV sedation, and 53 received troche sedation. Four patients receiving IV sedation reported nausea during and after the procedure (n=1, 1.9%) or pain during the procedure (n=3, 5.6%), whereas 3 patients receiving troche sedation reported dizziness after the procedure (n=1, 1.9%), and pain during the procedure (n=2, 3.8%). Although the troche group (mean=6.25, SD=3.94) spent less time in recovery than the IV group (mean=6.48, SD=2.61), the difference was not significant (t[df=105]=0.677, P>.05). In conclusion, the results showed comparable experiences for both groups with equivalency and effectiveness in providing patient comfort during cataract surgery.
Collapse
Affiliation(s)
- Jason C Smith
- is a faculty member, Nurse Anesthesia Program, College of Applied Studies, Florida State University, Panama City, Florida, and a practicing CRNA, Jackson Anesthesia Associates, Marianna, Florida
| | | | - Stacey A VanDyke
- is program administrator, Nurse Anesthesia Program, College of Applied Studies, Florida State University, Panama City
| |
Collapse
|
42
|
Kalogiannidis I, Tsakiridis I, Dagklis T, Kapetanios G, Mamopoulos A, Athanasiadis A. Comparison of the efficacy and safety of two combined misoprostol regimens for second trimester medical abortion. EUR J CONTRACEP REPR 2020; 26:42-47. [PMID: 33044101 DOI: 10.1080/13625187.2020.1830966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of the study was to compare the efficacy and safety of two combined misoprostol regimens for second trimester medical abortion. METHODS This was a retrospective cohort study examining data on singleton pregnancies that underwent second trimester medical abortion between November 2011 and November 2019 in a tertiary care centre in northern Greece. In the first study period (November 2011 to August 2015), the management protocol (protocol 1) consisted of 800 μg vaginal misoprostol followed by 400 μg oral misoprostol, every 3 h, for up to five doses. In the second study period (September 2015 to November 2019), a new protocol (protocol 2) was introduced, where the oral route was changed to sublingual, using the same dosage. The two routes were compared in terms of efficacy and safety. RESULTS The study comprised 85 women: 43 (50.6%) received the protocol 1 regimen (vaginal-oral), while 42 (49.4%) received the protocol 2 regimen (vaginal-sublingual). The groups did not differ in terms of maternal age, gestational age and parity. Sublingual misoprostol was more effective than oral misoprostol, both in terms of dose needed (median 1600 μg vs 2000 μg; p = 0.031) and induction-to-abortion interval (8 h vs 11 h; p = 0.001). Surgical evacuation due to incomplete abortion was necessary in 11.9% of women in the sublingual group vs 18.6% in the oral group (p = 0.394). Women in the sublingual group reported a higher rate of severe pain (odds ratio [OR] 6.061; 95% confidence interval [95% CI] 1.240, 29.619) and shivering (OR 4.632; 95% CI 1.788, 11.995). CONCLUSION The administration of vaginal-sublingual misoprostol, when compared with the vaginal-oral regimen, was associated with a shorter induction-to-abortion interval but a higher incidence of severe pain and shivering.
Collapse
Affiliation(s)
- Ioannis Kalogiannidis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Kapetanios
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
43
|
Zhou M, Derakhshanian S, Rath A, Bertrand S, DeGraw C, Barlow R, Menard A, Kaye AM, Hasoon J, Cornett EM, Kaye AD, Viswanath O, Urits I. Asenapine Transdermal Patch for the Management of Schizophrenia. Psychopharmacol Bull 2020; 50:60-82. [PMID: 33012873 PMCID: PMC7511145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose of Review This is a comprehensive review of the literature regarding the use of asenapine for the treatment of schizophrenia (SZ) in adults. It covers an introduction, epidemiology, risk factors, pathophysiology, and current treatment modalities regarding SZ, provides a background on the mechanism of action of asenapine, and then reviews the existing evidence for use of asenapine in both its sublingual and transdermal formulation in the treatment of SZ. Recent Findings SZ is a complex and multifactorial mental disorder which is thought to combine several genetic, epigenetic, and environmental factors causing abnormalities in the dopaminergic system. Symptoms are categorized in delusions, hallucinations, disorganization, and negative presentations like affective flattening and apathy. Current treatment focuses on antipsychotic medications by means of oral administration or long-acting injection. Asenapine is a second-generation antipsychotic with 5HT-2A antagonist and 5HT-1A/1B partial agonist properties, which provides a favorable profile in targeting schizophrenic symptoms, while reducing motor side effects and improving mood and cognition. Asenapine in its sublingual formulation was FDA approved for treatment of SZ and bipolar I disorder in adults in August of 2009 and has been proven to be both effective and safe. Transdermal patch of asenapine (Secuado) was FDA approved in October of 2019, the first and only FDA approved patch for SZ in adults, which offers another strategy for treatment to improve compliance and ease of administration. Summary SZ is a chronic and debilitating disease which is still not well understood and comes at great cost with regards to the quality of life for patients. Medication side-effects and compliance are enormous issues which take a toll on health care systems in industrialized nations and keep patients from achieving stability with their disease. Transdermal asenapine is a new first-in-class dosage form and provides a novel modality of administration. It has been shown to be effective in reducing positive, as well as negative symptoms, while still maintaining a favorable side-effect profile.
Collapse
Affiliation(s)
- Maxine Zhou
- Zhou, MD, Derakhshanian, MD, Rath, MD, Menard, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. Bertrand, BS, DeGraw, BS, Barlow, BS, Louisiana State University Shreveport School of Medicine. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Cornett, PhD, Kaye, MD, PhD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Sahar Derakhshanian
- Zhou, MD, Derakhshanian, MD, Rath, MD, Menard, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. Bertrand, BS, DeGraw, BS, Barlow, BS, Louisiana State University Shreveport School of Medicine. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Cornett, PhD, Kaye, MD, PhD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Alexander Rath
- Zhou, MD, Derakhshanian, MD, Rath, MD, Menard, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. Bertrand, BS, DeGraw, BS, Barlow, BS, Louisiana State University Shreveport School of Medicine. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Cornett, PhD, Kaye, MD, PhD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Sarah Bertrand
- Zhou, MD, Derakhshanian, MD, Rath, MD, Menard, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. Bertrand, BS, DeGraw, BS, Barlow, BS, Louisiana State University Shreveport School of Medicine. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Cornett, PhD, Kaye, MD, PhD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Caroline DeGraw
- Zhou, MD, Derakhshanian, MD, Rath, MD, Menard, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. Bertrand, BS, DeGraw, BS, Barlow, BS, Louisiana State University Shreveport School of Medicine. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Cornett, PhD, Kaye, MD, PhD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Rachel Barlow
- Zhou, MD, Derakhshanian, MD, Rath, MD, Menard, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. Bertrand, BS, DeGraw, BS, Barlow, BS, Louisiana State University Shreveport School of Medicine. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Cornett, PhD, Kaye, MD, PhD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Aja Menard
- Zhou, MD, Derakhshanian, MD, Rath, MD, Menard, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. Bertrand, BS, DeGraw, BS, Barlow, BS, Louisiana State University Shreveport School of Medicine. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Cornett, PhD, Kaye, MD, PhD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Adam M Kaye
- Zhou, MD, Derakhshanian, MD, Rath, MD, Menard, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. Bertrand, BS, DeGraw, BS, Barlow, BS, Louisiana State University Shreveport School of Medicine. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Cornett, PhD, Kaye, MD, PhD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Jamal Hasoon
- Zhou, MD, Derakhshanian, MD, Rath, MD, Menard, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. Bertrand, BS, DeGraw, BS, Barlow, BS, Louisiana State University Shreveport School of Medicine. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Cornett, PhD, Kaye, MD, PhD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Elyse M Cornett
- Zhou, MD, Derakhshanian, MD, Rath, MD, Menard, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. Bertrand, BS, DeGraw, BS, Barlow, BS, Louisiana State University Shreveport School of Medicine. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Cornett, PhD, Kaye, MD, PhD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Alan D Kaye
- Zhou, MD, Derakhshanian, MD, Rath, MD, Menard, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. Bertrand, BS, DeGraw, BS, Barlow, BS, Louisiana State University Shreveport School of Medicine. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Cornett, PhD, Kaye, MD, PhD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Omar Viswanath
- Zhou, MD, Derakhshanian, MD, Rath, MD, Menard, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. Bertrand, BS, DeGraw, BS, Barlow, BS, Louisiana State University Shreveport School of Medicine. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Cornett, PhD, Kaye, MD, PhD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Ivan Urits
- Zhou, MD, Derakhshanian, MD, Rath, MD, Menard, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry, and Behavioral Medicine. Bertrand, BS, DeGraw, BS, Barlow, BS, Louisiana State University Shreveport School of Medicine. Kaye, Pharm D, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Cornett, PhD, Kaye, MD, PhD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ. Urits, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| |
Collapse
|
44
|
Pelst MP, Höbart C, Wallaeys C, De Rooster H, Gansemans Y, Van Nieuwerburgh F, Devriendt B, Cox E. Adjuvanting Allergen Extracts for Sublingual Immunotherapy: Calcitriol Downregulates CXCL8 Production in Primary Sublingual Epithelial Cells. Front Immunol 2020; 11:1033. [PMID: 32582164 PMCID: PMC7295906 DOI: 10.3389/fimmu.2020.01033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/29/2020] [Indexed: 12/23/2022] Open
Abstract
Application of allergens onto the sublingual epithelium is used to desensitize allergic individuals, a treatment known as sublingual immunotherapy. However, the response of sublingual epithelial cells to house dust mite allergen and potential tolerance-promoting adjuvants such as Toll-like receptor (TLR) ligands and calcitriol has not been investigated. In order to study this, primary sublingual epithelial cells were isolated from dogs and cultured in vitro. After 24-h incubation with a Dermatophagoides farinae extract, a Dermatophagoides pteronyssinus extract, TLR2 ligands (FSL-1, heat-killed Listeria monocytogenes, Pam3CSK4), a TLR3 ligand (poly I:C), a TLR4 ligand [lipopolysaccharide (LPS)], and calcitriol (1,25-dihydroxyvitamin D3), viability of the cells was analyzed using an MTT test, and their secretion of interleukin 6 (IL-6), IL-10, CXCL8, and transforming growth factor β1 (TGF-β1) was measured by enzyme-linked immunosorbent assay. Additionally, to evaluate its potential effect as an adjuvant, sublingual epithelial cells were incubated with calcitriol in combination with a D. farinae extract followed by measurement of CXCL8 secretion. Furthermore, the effect of D. farinae and calcitriol on the transcriptome was assessed by RNA sequencing. The viability of the sublingual epithelial cells was significantly decreased by poly I:C, but not by the other stimuli. CXCL8 secretion was significantly increased by D. farinae extract and all TLR ligands apart from LPS. Calcitriol significantly decreased CXCL8 secretion, and coadministration with D. farinae extract reduced CXCL8 concentrations to levels seen in unstimulated sublingual epithelial cells. Although detectable, TGF-β1 secretion could not be modulated by any of the stimuli. Interleukin 6 and IL-10 could not be detected at the protein or at the mRNA level. It can be concluded that a D. farinae extract and TLR ligands augment the secretion of the proinflammatory chemokine CXCL8, which might interfere with sublingual desensitization. On the other hand, CXCL8 secretion was reduced by coapplication of calcitriol and a D. farinae extract. Calcitriol therefore seems to be a suitable candidate to be used as adjuvant during sublingual immunotherapy.
Collapse
Affiliation(s)
- Michael P Pelst
- Laboratory of Immunology, Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Clara Höbart
- Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Charlotte Wallaeys
- VIB Center for Inflammation Research, Ghent, Belgium.,Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | - Hilde De Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Yannick Gansemans
- Laboratory for Pharmaceutical Biotechnology, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Filip Van Nieuwerburgh
- Laboratory for Pharmaceutical Biotechnology, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Bert Devriendt
- Laboratory of Immunology, Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Eric Cox
- Laboratory of Immunology, Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| |
Collapse
|
45
|
Whittaker AL, Barker TH. The Impact of Common Recovery Blood Sampling Methods, in Mice (Mus Musculus), on Well-Being and Sample Quality: A Systematic Review. Animals (Basel) 2020; 10:E989. [PMID: 32517144 DOI: 10.3390/ani10060989] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/19/2022] Open
Abstract
Blood sampling is often performed in laboratory mice. Sampling techniques have the potential to cause pain, distress and impact on lifetime cumulative experience. In spite of institutions commonly providing guidance to researchers on these methods, and the existence of published guidelines, no systematic evaluation of the evidence on this topic exists. A systematic search of Medline, Scopus, and Web of Science was performed, identifying 27 studies on the impact of recovery blood sample techniques on mouse welfare and sample quality. Studies were appraised for quality using the SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) risk of bias tool. In spite of an acceptable number of studies being located, few studies examined the same pairwise comparisons. Additionally, there was considerable heterogeneity in study design and outcomes, with many studies being at a high risk of bias. Consequently, results were synthesised using the Synthesis Without Meta-analysis (SWiM) reporting guidelines. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was utilised for assessment of certainty in the evidence. Due to the heterogeneity and GRADE findings, it was concluded that there was not enough high-quality evidence to make any recommendations on the optimal method of blood sampling. Future high-quality studies, with standardised outcome measures and large sample sizes, are required.
Collapse
|
46
|
Azapağası E, Kendirli T, Perk O, Kutluk G, Öz Tunçer G, Teber S, Çobanoğlu N. Sublingual Atropine Sulfate Use for Sialorrhea in Pediatric Patients. J Pediatr Intensive Care 2020; 9:196-200. [PMID: 32685247 DOI: 10.1055/s-0040-1708552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/16/2020] [Indexed: 10/24/2022] Open
Abstract
Sialorrhea is a frequent problem and may lead to aspiration in patients with swallowing dysfunction. We aimed to assess the effectiveness and safety of sublingual atropine sulfate treatment in pediatric patients with sialorrhea. The medical records of patients who had received sublingual atropine sulfate between January 2015 and January 2016 were reviewed retrospectively. The demographic properties, diagnosis, invasive or noninvasive mechanical ventilation need, and the presence of tracheotomy were assessed. Response rates to sublingual atropine were measured using the Teacher Drooling Scale (TDS). Pre and post-treatment drooling scores were compared. Atropine sulfate ampoule was administered at 20 µg/kg/dose. Minimum dose was 0.25 mg, while maximum dose was 0.03 mg/kg.Thirty-five pediatric patients with sialorrhea who had received sublingual atropine sulfate were identified; however, TDS scores had been recorded in only 20 of them. The median age of the patients was 25 months (3-78 months; 7 girls, 13 boys). Sixteen (80%) patients were on invasive mechanical ventilation and seven (30%) had tracheotomy. Nineteen patients had a neurodevelopmental disorder and only one patient had oral and esophageal lesions due to corrosive material intake. The median TDS score prior to sublingual atropine sulfate treatment was 5, and it decreased to 3 on the second day of treatment, a change that was statistically significant ( p < 0.001). No side effects were observed. Sublingual atropine sulfate is safe and effective in the short-term treatment of sialorrhea; however, randomized placebo controlled and long-term follow-up studies are necessary.
Collapse
Affiliation(s)
- Ebru Azapağası
- Department of Pediatric Intensive Care, Ankara University Medical Faculty, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care, Ankara University Medical Faculty, Ankara, Turkey
| | - Oktay Perk
- Department of Pediatric Intensive Care, Ankara University Medical Faculty, Ankara, Turkey
| | - Gültekin Kutluk
- Department of Pediatric Neurology, Ankara University Medical Faculty, Ankara, Turkey
| | - Gökçen Öz Tunçer
- Department of Pediatric Neurology, Ankara University Medical Faculty, Ankara, Turkey
| | - Serap Teber
- Department of Pediatric Neurology, Ankara University Medical Faculty, Ankara, Turkey
| | - Nazan Çobanoğlu
- Department of Pediatric Pulmonology, Ankara University Medical Faculty, Ankara, Turkey
| |
Collapse
|
47
|
Mahler V, Esch RE, Kleine-Tebbe J, Lavery WJ, Plunkett G, Vieths S, Bernstein DI. Understanding differences in allergen immunotherapy products and practices in North America and Europe. J Allergy Clin Immunol 2019; 143:813-28. [PMID: 30850069 DOI: 10.1016/j.jaci.2019.01.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 01/13/2023]
Abstract
Allergen immunotherapy (AIT) is thought to be clinically effective and safe in treating allergic rhinitis, asthma, and stinging insect allergy in Europe and North America. However, there are intercontinental differences in AIT therapeutic products in terms of their application and regulation. In North America unmodified standardized and nonstandardized aqueous aeroallergen extracts are approved and used almost exclusively for subcutaneous immunotherapy, whereas more product options are available in Europe, including adsorbed allergens, chemically modified allergens, or both. Both liquid extracts and tablets are approved for sublingual immunotherapy in Europe. Nevertheless, within the European Union, there are major differences in AIT products approved and used in individual countries. There are major differences in the clinical approach to subcutaneous immunotherapy in polysensitized patients; in the United States mixed extracts containing multiple aeroallergens are used, whereas European allergists preferably administer separate injections of single allergen sources or homologous groups deemed to be clinically relevant. Moreover, the regulatory approach differs between the European Union and United States. In contrast to the United States, where common allergen standards exist based on biologic activity, no common standards exist in Europe. In terms of development of new investigational products, the United States has followed the European example for phase II and III studies; no formal US Food and Drug Administration guidance has been issued.
Collapse
|
48
|
Durocher J, Aguirre JD, Dzuba IG, Mirta Morales E, Carroli G, Esquivel J, Martin R, Berecoechea C, Winikoff B. High fever after sublingual administration of misoprostol for treatment of post-partum haemorrhage: a hospital-based, prospective observational study in Argentina. Trop Med Int Health 2020; 25:714-722. [PMID: 32155681 PMCID: PMC7317539 DOI: 10.1111/tmi.13389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective To characterise the occurrence of fever (≥38.0°C) after treatment for post‐partum haemorrhage (PPH) with sublingual misoprostol 800 mcg in Latin America, where elevated rates of misoprostol’s thermoregulatory effects and recipients’ increased susceptibility to high fever have been documented. Methods A prospective observational study in hospitals in Argentina enrolled consenting women with atonic PPH after vaginal delivery, eligible to receive misoprostol. Corporal temperature was assessed at 30, 60, 90 and 120 min post‐treatment; other effects were recorded. The incidence of high fever ≥ 40.0°C (primary outcome) was compared to the rate observed previously in Ecuador. Logistic regressions were performed to identify clinical and population‐based predictors of misoprostol‐induced fever. Results Transient shivering and fever were experienced by 75.5% (37/49) of treated participants and described as acceptable by three‐quarters of women interviewed (35/47). The high fever rate was 12.2% (6/49), [95% Confidence Interval (CI) 4.6, 24.8], compared to Ecuador’s rate following misoprostol treatment (35.6% (58/163) [95% CI 28.3, 43.5], P = 0.002). Significant predictors of misoprostol‐induced fever (model dependent) were as follows: pre‐delivery haemoglobin < 11.0g/dl, rapid placental expulsion, and higher age of the woman. No serious outcomes were reported prior to discharge. Conclusions Misoprostol to treat PPH in Argentina resulted in a significantly lower rate of high fever than in Ecuador, although both are notably higher than rates seen elsewhere. A greater understanding of misoprostol’s side effects and factors involved in their occurrence, including genetics, will help alleviate concerns. The onset of shivering may be the simplest way to know if fever can also be expected.
Collapse
Affiliation(s)
| | | | | | | | | | - Jesica Esquivel
- Hospital Materno Neonatal E.T. de Vidal, Corrientes, Argentina
| | | | | | | |
Collapse
|
49
|
Miner JR. Sublingual analgesia: a promising proposal for the treatment of pain. Expert Opin Drug Deliv 2020; 17:123-126. [PMID: 31933384 DOI: 10.1080/17425247.2020.1714588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- James R Miner
- Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.,Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
50
|
Allikmets S, Vink JP. Clinical applications of buprenorphine depot injection for opioid use disorder. Addiction 2020; 115:190. [PMID: 31521065 DOI: 10.1111/add.14818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/04/2019] [Accepted: 09/08/2019] [Indexed: 12/18/2022]
|