Intramuscular and rectal therapies of acute seizures

Leppik, Ilo E.; Patel, Sana

doi:10.1016/j.yebeh.2015.05.001

Cited by 26 publications

(12 citation statements)

References 70 publications

(76 reference statements)

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“…The rectum is the final portion of the large intestine that starts from the end of the sigmoid colon to the anal canal. It primarily acts as a transportation (conduit) or temporary storage site in the defecation process, with only minimal involvement in the absorption of water and electrolytes from the gastrointestinal contents (Shafik et al, 2006; Leppik and Patel, 2015). Fecal matter is stored by the rectum if it is small in volume until it reaches a degree of rectal distension sufficient to initiate the defecation reflex (Shafik et al, 2006).…”

Section: Functional Anatomymentioning

confidence: 99%

“…Suppositories can be designed to have different rates and degrees of drug release for absorption. In particular, the composition of the suppository base, including the use of surfactants or other additives, and the physicochemical properties of the drug (e.g., solubility and particle size) can confer different drug release profiles (Nunes et al, 2014; Leppik and Patel, 2015). For drugs that are dissolved (soluble) in the suppository base, drug release occurs as the suppository dissolves or melts onto the mucosal surface where the drug molecules then diffuse out.…”

Section: Conventional Rectal Drug Delivery Approachesmentioning

confidence: 99%

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Physiological and Pharmaceutical Considerations for Rectal Drug Formulations

Hua

2019

Front. Pharmacol.

129

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Although the oral route is the most convenient route for drug administration, there are a number of circumstances where this is not possible from either a clinical or pharmaceutical perspective. In these cases, the rectal route may represent a practical alternative and can be used to administer drugs for both local and systemic actions. The environment in the rectum is considered relatively constant and stable and has low enzymatic activity in comparison to other sections of the gastrointestinal tract. In addition, drugs can partially bypass the liver following systemic absorption, which reduces the hepatic first-pass effect. Therefore, rectal drug delivery can provide significant local and systemic levels for various drugs, despite the relatively small surface area of the rectal mucosa. Further development and optimization of rectal drug formulations have led to improvements in drug bioavailability, formulation retention, and drug release kinetics. However, despite the pharmaceutical advances in rectal drug delivery, very few of them have translated to the clinical phase. This review will address the physiological and pharmaceutical considerations influencing rectal drug delivery as well as the conventional and novel drug delivery approaches. The translational challenges and development aspects of novel formulations will also be discussed.

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Section: Functional Anatomymentioning

confidence: 99%

Section: Conventional Rectal Drug Delivery Approachesmentioning

confidence: 99%

Physiological and Pharmaceutical Considerations for Rectal Drug Formulations

Hua

2019

Front. Pharmacol.

129

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“…Hastane dışında kullanımının güvenli ve etkili olduğu bildirilmektedir (14)(15)(16) . Çalışmamızda, ebeveynlerin yarısından fazlasının bilgilendirilmelerine rağmen, rektal ilaç uygulamasına sıcak bakmadı-ğı görülmekle birlikte, bu oran yurt dışında yapılan bir çalışmada, %19 olarak belirtilmiştir (14) . Yurt dışında diğer kullanım yollarına (nazal, bukkal) uygun ilaçlar bulunmasına karşın, bunlar ülkemizde temin edilememektedir.…”

Section: Discussionunclassified

The knowledge, attitudes and behaviors of parents for the non-hospital management of seizures who have children with recurrent seizures

Kanık¹,

Ince²,

İnce³

et al. 2015

Buch

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ÖZETAmaç: Yineleyen nöbetleri olan çocuklarda ebeveynlere hastane dışında nöbete yaklaşım ile ilgili yeterli bilgi verilmelidir. Bu çalışmada, epilepsi ve yineleyen febril konvulsiyonlu olguların aileleri ile görüşülerek hastane dışında nöbet geçirmesi durumunda nöbet geçiren çocuğa karşı yaklaşımları ve ailelerin nöbet yönetimi konusunda gereksinimlerini saptamak amaçlandı. Yöntemler: Bu çalışma, Eylül 2014 ve Şubat 2015 tarihleri arasında Çocuk Nöroloji Polikliniğine başvuran, yineleyen nöbet öyküsü olan 280 çocuğun aileleri ile anket formu üzerinden görüşüle-rek yapıldı. Bulgular: Çalışmaya 223 (%79,6)'ü epilepsi, 57 (%20,4)'si yineleyen febril konvulsiyon tanısı olan 280 olgu alındı. Ebeveynlerin 194 (%69,3)'ü nöbet sırasında müdahale ile ilgili yazılı olmayan bilgi aldığını belirtti. Nöbet sırasında evde en sık yapılan ilk uygulama olguların %26,8 (n=75) ile pozisyon verme şeklindeydi. Nöbetin uzaması durumunda rektal diazepam uygulaması olguların 120 (%42,8)'sinde yapılırken 160 olguda çeşitli nedenlerle uygulanmadığı belirtildi. Rektal ilaç uygulama oranı gelir düzeyinin artması ve hastalık takip süresinin uzun olması ile ilişkili bulundu (p değeri sırasıyla 0,029 ve 0,037). Nöbet sırasında yapılması önerilen doğru uygulamaların gelir ve öğrenim düzeyi ile anlamlı oranda artış gösterdiği saptandı. Sonuç: Yineleyen nöbeti olan çocukların ebeveynlerinin nöbet kontrolü konusunda yetersiz, yanlış bilgi ve ilk yardım pratiğine sahip oldukları saptanmıştır. Bu nedenle ebeveynlerin nöbet yönetimi ile ilgili düzenli bir eğitime tabi tutulma gerekliliği görülmüştür.Anahtar kelimeler: Epilepsi, febril nöbet, çocuk, ebeveyn bilgisi ABSTRACT Objective: Sufficient information should be given to parents who have children with recurrent seizures about the approach to seizures outside the hospital. This study was aimed to identify the approach of the parents towards children with recurrent febrile seizures and epilepsy, and their requirements about management of seizures outside the hospital. Methods: This study has been conducted between September 2014 and February 2015 using an interview questionnaire with the parents of the children who were admitted to the pediatric neurology outpatient clinic with a history of seizure. Results: The study included 223 (79.6%) cases with epilepsy, and 57 (20.4%) patients (total n=280) who received diagnosis of recurrent febrile seizures. A total of 194 (69.3%) parents said that they received oral information regarding the management of seizures. The most often application during seizures in 26.8% (n=75) of the cases was positioning the patient. Rectal administration of diazepam was the most common intervention for prolonged seizure in 120 (42.8%) cases, however in 160 cases it was not applied for various reasons. Frequency of rectal administration of the drugs was found to be associated with income level and the longer follow-up period (p-values of 0.029 and 0.037, respectively). It was detected that with the higher education and income levels, frequency of recommended correct applica...

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“…As the rectal mucosa is highly vascularised, this route of administration is useful for rapid systemic drug absorption, particularly in an emergency or when the oral route is unavailable. Rectal formulations have been used in pain management [ 102 , 103 ], sedation [ 104 ] and treatment of seizures [ 105 ]. Compared to other transmucosal routes of administration, one of the distinct advantages of rectal delivery is that it is not limited by vomiting which patients commonly experience as they approach the ends of their lives.…”

Section: Rectal Deliverymentioning

confidence: 99%

Transmucosal drug administration as an alternative route in palliative and end-of-life care during the COVID-19 pandemic

Lam

Cheung

Chow

et al. 2020

Advanced Drug Delivery Reviews

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The Coronavirus disease 2019 (COVID-19) pandemic has led to a surge in need for alternative routes of administration of drugs for end of life and palliative care, particularly in community settings. Transmucosal routes include intranasal, buccal, sublingual and rectal. They are non-invasive routes for systemic drug delivery with the possibility of self-administration, or administration by family caregivers. In addition, their ability to offer rapid onset of action with reduced first-pass metabolism make them suitable for use in palliative and end-of-life care to provide fast relief of symptoms. This is particularly important in COVID-19, as patients can deteriorate rapidly. Despite the advantages, these routes of administration face challenges including a relatively small surface area for effective drug absorption, small volume of fluid for drug dissolution and the presence of a mucus barrier, thereby limiting the number of drugs that are suitable to be delivered through the transmucosal route. In this review, the merits, challenges and limitations of each of these transmucosal routes are discussed. The goals are to provide insights into using transmucosal drug delivery to bring about the best possible symptom management for patients at the end of life, and to inspire scientists to develop new delivery systems to provide effective symptom management for this group of patients.

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Intramuscular and rectal therapies of acute seizures

Cited by 26 publications

References 70 publications

Physiological and Pharmaceutical Considerations for Rectal Drug Formulations

Physiological and Pharmaceutical Considerations for Rectal Drug Formulations

The knowledge, attitudes and behaviors of parents for the non-hospital management of seizures who have children with recurrent seizures

Transmucosal drug administration as an alternative route in palliative and end-of-life care during the COVID-19 pandemic

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