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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] [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.
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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
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Parrot M, Yathavan B, Averin O, Hoggard L, Rower JE, Voight M, Greene D, Tarrell A, Whelan A, Ghandehari H, Murphy N, Yellepeddi V. Clinical pharmacokinetics of atropine oral gel formulation in healthy volunteers. Clin Transl Sci 2024; 17:e13753. [PMID: 38465519 PMCID: PMC10926053 DOI: 10.1111/cts.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/01/2024] [Accepted: 02/14/2024] [Indexed: 03/12/2024] Open
Abstract
Sialorrhea or drooling is a common problem in children and adults with neurodevelopmental disorders. It can negatively impact the quality of life due to its physical and psychological manifestations. Providers commonly prescribe atropine eye drops for topical administration to the oral mucosa, as an off-label treatment to manage sialorrhea. However, the off-label use of atropine eye drops can be associated with medication and dosing errors and systemic side effects. To address these limitations of treatment, we developed a mucoadhesive topical oral gel formulation of atropine as an alternative route to off-label administration of atropine eye drops. In this clinical pharmacokinetic (PK) study, we evaluated the safety and PK of atropine gel (0.01% w/w) formulation after single-dose administration to the oral mucosa in 10 healthy volunteers. The PK data showed that after topical administration to the oral mucosa, atropine followed a two-compartment PK profile. The maximum plasma concentration and area under the curve extrapolated to infinite time were 0.14 ng/mL and 0.74 h·ng·mL-1 , respectively. The absorption rate constant calculated by the compartmental analysis was 0.4 h-1 . Safety parameters, such as heart rate, blood pressure, and oxygen saturation, did not significantly change before and after administration of the gel formulation, and no adverse events were observed in all participants who received atropine gel. These data indicate that atropine gel formulation has a satisfactory PK profile, is well-tolerated at the dose studied, and can be further considered for clinical development as a drug product to treat sialorrhea.
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Affiliation(s)
- Madison Parrot
- Division of Clinical Pharmacology, Department of Pediatrics, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUtahUSA
- Department of Molecular Pharmaceutics, Utah Center for Nanomedicine, College of PharmacyUniversity of UtahSalt Lake CityUtahUSA
| | - Bhuvanesh Yathavan
- Department of Molecular Pharmaceutics, Utah Center for Nanomedicine, College of PharmacyUniversity of UtahSalt Lake CityUtahUSA
| | - Olga Averin
- Department of Pharmacology and Toxicology and Center for Human ToxicologyUniversity of UtahSalt Lake CityUtahUSA
| | - Logan Hoggard
- Department of Pharmacology and Toxicology and Center for Human ToxicologyUniversity of UtahSalt Lake CityUtahUSA
| | - Joseph E. Rower
- Department of Pharmacology and Toxicology and Center for Human ToxicologyUniversity of UtahSalt Lake CityUtahUSA
| | - Michael Voight
- Investigational Drug Service, Pharmacy Services, University of Utah HospitalSalt Lake CityUtahUSA
| | - Danielle Greene
- Division of Clinical Pharmacology, Department of Pediatrics, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Ariel Tarrell
- Division of Clinical Pharmacology, Department of Pediatrics, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Aviva Whelan
- Division of Clinical Pharmacology, Department of Pediatrics, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Hamidreza Ghandehari
- Department of Molecular Pharmaceutics, Utah Center for Nanomedicine, College of PharmacyUniversity of UtahSalt Lake CityUtahUSA
| | - Nancy Murphy
- Division of Complex Care, Department of PediatricsUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Venkata Yellepeddi
- Division of Clinical Pharmacology, Department of Pediatrics, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUtahUSA
- Department of Molecular Pharmaceutics, Utah Center for Nanomedicine, College of PharmacyUniversity of UtahSalt Lake CityUtahUSA
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Daniel SJ, Fayoux P, Bateman N, Boudewyns A, Brigger M, Chan CY, Chan K, Cheng A, Conley S, Kubba H, Lambert EM, Muntz H, Nuss R, Russell J, Rutter M, Schwarz Y, Spratley J, Thevasagayam R, Thompson D, Valika T, Wyatt M. Comprehensive management of anterior drooling: An International Pediatric Otolaryngology Group (IPOG) consensus statement. Int J Pediatr Otorhinolaryngol 2023; 168:111500. [PMID: 36990032 DOI: 10.1016/j.ijporl.2023.111500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/17/2023] [Accepted: 03/01/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To provide guidance for the comprehensive management of children referred for anterior drooling. The mission of the International Pediatric Otolaryngology Group (IPOG) is to develop expertise-based recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. METHODS Survey of expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The recommendations are derived from current expert consensus and critical review of the literature. RESULTS Consensus recommendations include initial care and approach recommendations for health care providers who commonly evaluate children with drooling. This includes evaluation and treatment considerations for commonly debated issues in drooling management, initial work-up of children referred for anterior drooling, treatment recommendations, indications and contra-indications for rehabilitation, medical, and surgical management, as well as pros and cons of different surgical procedures in the hands of drooling management experts. CONCLUSION Anterior drooling consensus recommendations are aimed at improving patient-centered care in children referred for sialorrhea.
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Affiliation(s)
- Sam J Daniel
- Department of Otolaryngology - Head and Neck Surgery, McGill University Health Center, Montreal Children's Hospital, McGill University, Quebec, Canada.
| | - Pierre Fayoux
- Department of Otolaryngology - Head and Neck Surgery, CHU Lille, F-59000, Lille, France.
| | - Neil Bateman
- Department of Pediatric Otolaryngology, The University of Manchester, Royal Manchester Children's Hospital, England, UK.
| | - An Boudewyns
- Department of Otolaryngology - Head and Neck Surgery, University of Antwerp, Antwerp University Hospital, Belgium.
| | - Matthew Brigger
- Department of Otolaryngology - Head and Neck Surgery, UC San Diego School of Medicine, Rady Children's Hospital, San Diego, USA.
| | - Ching Yee Chan
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore.
| | - Kenny Chan
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, USA.
| | - Alan Cheng
- Department of Pediatric Otolaryngology, The University of Sydney, The Sydney Children's Hospital Network- Westmead Campus, Sydney, Australia.
| | - Stephen Conley
- Department of Otolarynology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Haytham Kubba
- Department of Otolaryngology, University of Glasgow, Glasgow Children's Hospital, Glasgow, Scotland, UK.
| | - Elton M Lambert
- Department of Otolaryngology, Baylor College of Medicine, Texas Children's Hospital, Texas, USA.
| | - Harlan Muntz
- Department of Otolaryngology, UC Davis Children's Hospital, Sacramento, CA, USA.
| | - Roger Nuss
- Division of Pediatric Otolaryngology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - John Russell
- Department of Otolaryngology, Children's Health Ireland(CHI) at Crumlin, Dublin, Ireland.
| | - Mike Rutter
- Department of Otolaryngology- Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Yehuda Schwarz
- Department of Otolaryngology- Head and Neck Surgery, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - Jorge Spratley
- Pediatric Otorhinolaryngology, University of Porto Faculty of Medicine, S. Joao Hospital Center, CINTESIS, Porto, Portugal.
| | - Ravi Thevasagayam
- Department of Paediatric Otolaryngology, Sheffield Children's Hospital, UK.
| | - Dana Thompson
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.
| | - Taher Valika
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.
| | - Michelle Wyatt
- Paediatric Otolaryngologist, Great Ormond Street Hospital, London, England, UK.
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Liu C, Song C, Wang Y, Xiao Y, Zhou Z, Cao G, Sun X, Liu Y. Deep-fried Atractylodes lancea rhizome alleviates spleen deficiency diarrhea-induced short-chain fatty acid metabolic disorder in mice by remodeling the intestinal flora. JOURNAL OF ETHNOPHARMACOLOGY 2023; 303:115967. [PMID: 36442762 DOI: 10.1016/j.jep.2022.115967] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/01/2022] [Accepted: 11/22/2022] [Indexed: 06/16/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Atractylodes lancea (Thunb.) DC. is a Chinese herb that has been commonly used to treat spleen-deficiency diarrhea (SDD) in China for over a thousand years. However, the underlying mechanism of its antidiarrheal activity is not fully understood. AIM OF THE STUDY The antidiarrheal effects of the ethanol extract of deep-fried A. lancea rhizome (EEDAR) due to spleen deficiency induced by folium sennae (SE) were determined on the regulation of the short-chain fatty acid (SCFA) metabonomics induced by the intestinal flora. MATERIALS AND METHODS The effects of EEDAR on a SE-induced mouse model of SDD were evaluated by monitoring the animal weight, fecal water content, diarrhea-grade rating, goblet cell loss, and pathological changes in the colon. The expression of inflammatory factors (tumor necrosis factor [TNF]-α, interleukin [IL]-1β, IL-6, IL-10), aquaporins (AQP3, AQP4, and AQP8), and tight junction markers (ZO-1, occludin, claudin-1) in colon tissues were determined using quantitative polymerase chain reaction and western blotting. SCFA metabonomics in the feces of mice treated with EEDAR was evaluated using gas chromatography-mass spectrometry. Furthermore, 16S rDNA sequencing was used to determine the effect of EEDAR on the intestinal flora of SDD mice, and fecal microbiota transplantation (FMT) was used to confirm whether the intestinal flora was essential for the anti-SDD effect of EEDAR. RESULTS Treatment with EEDAR significantly improved the symptoms of mice with SDD by inhibiting the loss of colonic cup cells, alleviating colitis, and promoting the expression of AQPs and tight junction markers. More importantly, the effect of EEDAR on the increase of SCFA content in mice with SDD was closely related to the gut microbiota composition. EEDAR intervention did not significantly improve intestinal inflammation or the barrier of germ-free SDD mice, but FMT was effective. CONCLUSION EEDAR alleviated SE-induced SDD in mice, as well as the induced SCFA disorder by regulating the imbalance of the intestinal microbiota.
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Affiliation(s)
- Chunlian Liu
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan, 430065, China.
| | - Chengcheng Song
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan, 430065, China.
| | - Yan Wang
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan, 430065, China.
| | - Yangxin Xiao
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan, 430065, China.
| | - Zhongshi Zhou
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan, 430065, China; Center for Hubei TCM Processing Technology Engineering, Wuhan, 430065, China.
| | - Guosheng Cao
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan, 430065, China; Center for Hubei TCM Processing Technology Engineering, Wuhan, 430065, China.
| | - Xiongjie Sun
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan, 430065, China; Center for Hubei TCM Processing Technology Engineering, Wuhan, 430065, China.
| | - Yanju Liu
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan, 430065, China; Center for Hubei TCM Processing Technology Engineering, Wuhan, 430065, China.
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