Comparison of intravenous and intranasal administration of epinephrine during CPR in a canine model

Bleske, Barry E.; Warren, Eric W.; Rice, Ted L.; Shea, Michael J.; Amidon, Gordon L.; Knight, Paul R.

doi:10.1016/s0196-0644(05)80657-2

Cited by 30 publications

(17 citation statements)

References 8 publications

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“…The nasal mucosa represents a highly permeable route of drug absorption, and a number of drugs are absorbed systemically at this site. Intranasal administration of epinephrine during cardiac arrest and cardiopulmonary resuscitation has been attempted in dogs (Bleske et al 1992) while IN sedatives and analgesics have been used in human paediatric patients (Wilton et al 1988;Rey et al 1991;Karl et al 1992;Kendall et al 2001). The attainment of significant plasma midazolam concentrations occurs as early as 10 minutes after IN administration in human beings (Walbergh et al 1991).…”

Section: Discussionmentioning

confidence: 99%

Clinical evaluation of intranasal benzodiazepines, α2-agonists and their antagonists in canaries

Vesal

Zare

2006

Veterinary Anaesthesia and Analgesia

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Section: Discussionmentioning

confidence: 99%

Clinical evaluation of intranasal benzodiazepines, α2-agonists and their antagonists in canaries

Vesal

Zare

2006

Veterinary Anaesthesia and Analgesia

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“…Though there are many known advantages of IN administration, the literature regarding the use of IN epinephrine to treat anaphylaxis is limited. There are only a few studies that have investigated IN epinephrine 27‐29 . Two preclinical studies showed that IN epinephrine rapidly increased plasma epinephrine concentrations and improved coronary blood flow during cardiopulmonary resuscitation in dogs 28,29 .…”

Section: Discussionmentioning

confidence: 99%

“…There are only a few studies that have investigated IN epinephrine 27‐29 . Two preclinical studies showed that IN epinephrine rapidly increased plasma epinephrine concentrations and improved coronary blood flow during cardiopulmonary resuscitation in dogs 28,29 . These studies required the use of higher doses of epinephrine (7.5 to 14 mg) due to the compromised cardiovascular system of the dogs during ventricular fibrillation.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, only one preliminary clinical study has been conducted, which investigated epinephrine pharmacokinetic (PK) after IN versus IM administration in five participants 27 . Likewise, only two preclinical studies on IN epinephrine have been published, which were conducted in dogs with compromised cardiovascular activity during ventricular fibrillation 28,29 . We have conducted the current study in dogs to expand upon the literature knowledge base on IN epinephrine, and to provide the platform for future clinical studies.…”

Section: Introductionmentioning

confidence: 99%

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Intranasal epinephrine in dogs: Pharmacokinetic and heart rate effects

Dretchen

Mesa

Robben³

et al. 2020

Pharmacology Res & Perspec

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Epinephrine is the standard of care for the treatment of severe allergy and anaphylaxis. Epinephrine is most often administered through the intramuscular (IM) route via autoinjector. The current study aimed to evaluate an alternative method of epinephrine treatment through intranasal (IN) delivery in dogs. The pharmacokinetic (PK) parameters of maximum plasma concentration (Cmax), time to reach maximum plasma concentration (Tmax), and area under the plasma concentration‐time curve from 0 to 90 minutes (AUC0–90) were observed after IN epinephrine (2, 3, 4, 5, 10, and 20 mg) and IM epinephrine via autoinjector (0.15 and 0.3 mg) for 90 minutes. Heart rate effects were measured after IN (2 and 5 mg) and IM (0.15 and 0.3 mg) epinephrine administration. IN epinephrine (5 mg) demonstrated significantly greater plasma epinephrine concentration at 1 minute as compared with IM epinephrine (0.3 mg) (1.68 ± 0.65 ng/mL vs 0.21 ± 0.08 ng/mL, P = .03). There were no significant differences in Cmax, Tmax, and AUC0–90 between 2‐mg IN and 0.15‐mg IM epinephrine or between 5‐mg IN and 0.3‐mg IM epinephrine. IN epinephrine reduced heart rate increases, as compared to IM epinephrine. IN and IM epinephrine were both well‐tolerated. Overall, IN epinephrine demonstrated advantages over IM epinephrine, including the rapid increase in plasma epinephrine and lack of increased heart rate over time.

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“…Similarly, nasal spray method could increase the quantity of VIP (vasoactive intestinal peptide) entering the brain and protect the central nervous system. Hence, drugs sent through intranasal route cause minor irritation, which resolve spontaneously within a week at the end of the treatment [56]. More often, intranasal delivery is a noninvasive, safe (Figure 2, Table 1), and alternative approach which rapidly targets delivery of molecules to the brain while minimizing systemic exposure [57].…”

Section: Cns Protectionmentioning

confidence: 99%

Drug Delivery Systems, CNS Protection, and the Blood Brain Barrier

Upadhyay

2014

BioMed Research International

350

222

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Present review highlights various drug delivery systems used for delivery of pharmaceutical agents mainly antibiotics, antineoplastic agents, neuropeptides, and other therapeutic substances through the endothelial capillaries (BBB) for CNS therapeutics. In addition, the use of ultrasound in delivery of therapeutic agents/biomolecules such as proline rich peptides, prodrugs, radiopharmaceuticals, proteins, immunoglobulins, and chimeric peptides to the target sites in deep tissue locations inside tumor sites of brain has been explained. In addition, therapeutic applications of various types of nanoparticles such as chitosan based nanomers, dendrimers, carbon nanotubes, niosomes, beta cyclodextrin carriers, cholesterol mediated cationic solid lipid nanoparticles, colloidal drug carriers, liposomes, and micelles have been discussed with their recent advancements. Emphasis has been given on the need of physiological and therapeutic optimization of existing drug delivery methods and their carriers to deliver therapeutic amount of drug into the brain for treatment of various neurological diseases and disorders. Further, strong recommendations are being made to develop nanosized drug carriers/vehicles and noninvasive therapeutic alternatives of conventional methods for better therapeutics of CNS related diseases. Hence, there is an urgent need to design nontoxic biocompatible drugs and develop noninvasive delivery methods to check posttreatment clinical fatalities in neuropatients which occur due to existing highly toxic invasive drugs and treatment methods.

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Comparison of intravenous and intranasal administration of epinephrine during CPR in a canine model

Cited by 30 publications

References 8 publications

Clinical evaluation of intranasal benzodiazepines, α2-agonists and their antagonists in canaries

Clinical evaluation of intranasal benzodiazepines, α2-agonists and their antagonists in canaries

Intranasal epinephrine in dogs: Pharmacokinetic and heart rate effects

Drug Delivery Systems, CNS Protection, and the Blood Brain Barrier

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