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A Review of the Pharmacokinetic Profile of Transmucosal Fentanyl Formulations.
MedLine Citation:
PMID:  23020252     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Abstract Background and objectives: Breakthrough pain (BTP) is a transitory flare of moderate to severe pain that occurs in patients with stable, controlled persistent pain. Management of BTP episodes is difficult because frequency, time-to-peak intensity, and duration of episodes vary both within and between individuals. Formulations of fentanyl that use a buccal, sublingual, or nasal transmucosal route of administration have been developed for the treatment of BTP in opioid-tolerant patients with cancer. These formulations allow rapid passage into the bloodstream and avoid first-pass metabolism and, therefore, are more likely to match the time-course of BTP episodes than are oral formulations. The purposes of this analysis were to identify and review published data describing the pharmacokinetic properties of rapid-onset fentanyl formulations and to evaluate these properties in view of the temporal dynamic characteristics of BTP in order to help guide medical practice. Methods: Relevant publications were searched in the PubMed database from 1998. The plasma drug concentration-vs.-time profile of each formulation obtained from the identified studies was adjusted to a consistent scale for comparison. Results: The data revealed that the various transmucosal formulations resulted in three typical plasma fentanyl concentration profiles: 1) type 1: a very rapid rise and short duration; 2) type 2: a rapid increase and sustained intensity; and 3) type 3: a slower onset and longer duration. Conclusions: Given the substantial variability of BTP episodes experienced by patients, these pharmacokinetic differences may provide useful information for a physician who is selecting a rapid-onset opioid medication for a patient.
Authors:
Nicholas Moore; Mona Darwish; Xavier Amores; Hélène Schneid
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-1
Journal Detail:
Title:  Current medical research and opinion     Volume:  -     ISSN:  1473-4877     ISO Abbreviation:  Curr Med Res Opin     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0351014     Medline TA:  Curr Med Res Opin     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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