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Baird A, White SA, Das R, Tatum N, Bisgaard EK. Whole body physiology model to simulate respiratory depression of fentanyl and associated naloxone reversal. COMMUNICATIONS MEDICINE 2024; 4:114. [PMID: 38866911 PMCID: PMC11169242 DOI: 10.1038/s43856-024-00536-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/31/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Opioid use in the United States and abroad is an endemic part of society with yearly increases in overdose rates and deaths. In response, the use of the safe and effective reversal agent, naloxone, is being fielded and used by emergency medical technicians at a greater rate. There is evidence that repeated dosing of a naloxone nasal spray is becoming more common. Despite this we lack repeated dosing guidelines as a function of the amount of opiate the patient has taken. METHODS To measure repeat dosing guidelines, we construct a whole-body model of the pharmacokinetics and dynamics of an opiate, fentanyl on respiratory depression. We then construct a model of nasal deposition and administration of naloxone to investigate repeat dosing requirements for large overdose scenarios. We run a single patient through multiple goal directed resuscitation protocols and measure total naloxone administered. RESULTS Here we show that naloxone is highly effective at reversing the respiratory symptoms of the patient and recommend dosing requirements as a function of the fentanyl amount administered. We show that for increasing doses of fentanyl, naloxone requirements also increase. The rescue dose displays a nonlinear response to the initial opioid dose. This nonlinear response is largely logistic with three distinct phases: onset, rapid acceleration, and a plateau period for doses above 1.2 mg. CONCLUSIONS This paper investigates the total naloxone dose needed to properly reverse respiratory depression associated with fentanyl overdose. We show that the current guidelines for a rescue dose may be much lower than required.
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Affiliation(s)
- Austin Baird
- University of Washington Department of Surgery, Division of Healthcare Simulation Sciences, Seattle, WA, USA.
| | - Steven A White
- Applied Research Associated Southeast Division, Raleigh, NC, USA
| | - Rishi Das
- Applied Research Associated Southeast Division, Raleigh, NC, USA
| | - Nathan Tatum
- Applied Research Associated Southeast Division, Raleigh, NC, USA
| | - Erika K Bisgaard
- University of Washington Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, Seattle, WA, USA
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Ghosh A, Majie A, Karmakar V, Chatterjee K, Chakraborty S, Pandey M, Jain N, Roy Sarkar S, Nair AB, Gorain B. In-depth Mechanism, Challenges, and Opportunities of Delivering Therapeutics in Brain Using Intranasal Route. AAPS PharmSciTech 2024; 25:96. [PMID: 38710855 DOI: 10.1208/s12249-024-02810-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/16/2024] [Indexed: 05/08/2024] Open
Abstract
Central nervous system-related disorders have become a continuing threat to human life and the current statistic indicates an increasing trend of such disorders worldwide. The primary therapeutic challenge, despite the availability of therapies for these disorders, is to sustain the drug's effective concentration in the brain while limiting its accumulation in non-targeted areas. This is attributed to the presence of the blood-brain barrier and first-pass metabolism which limits the transportation of drugs to the brain irrespective of popular and conventional routes of drug administration. Therefore, there is a demand to practice alternative routes for predictable drug delivery using advanced drug delivery carriers to overcome the said obstacles. Recent research attracted attention to intranasal-to-brain drug delivery for promising targeting therapeutics in the brain. This review emphasizes the mechanisms to deliver therapeutics via different pathways for nose-to-brain drug delivery with recent advancements in delivery and formulation aspects. Concurrently, for the benefit of future studies, the difficulties in administering medications by intranasal pathway have also been highlighted.
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Affiliation(s)
- Arya Ghosh
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, India
| | - Ankit Majie
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, India
| | - Varnita Karmakar
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, India
| | - Kaberi Chatterjee
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, India
| | - Swarup Chakraborty
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, India
| | - Manisha Pandey
- Department of Pharmaceutical Sciences, Central University of Haryana, Mahendergarh, 123031, India
| | - Neha Jain
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Noida, U.P., India
| | - Suparna Roy Sarkar
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, India
| | - Anroop B Nair
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, 31982, Saudi Arabia
| | - Bapi Gorain
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, India.
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In Vitro Regional Deposition of Nasal Sprays in an Idealized Nasal Inlet: Comparison with In Vivo Gamma Scintigraphy. Pharm Res 2022; 39:3021-3028. [DOI: 10.1007/s11095-022-03388-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022]
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Kolanjiyil AV, Alfaifi A, Aladwani G, Golshahi L, Longest W. Importance of Spray–Wall Interaction and Post-Deposition Liquid Motion in the Transport and Delivery of Pharmaceutical Nasal Sprays. Pharmaceutics 2022; 14:pharmaceutics14050956. [PMID: 35631539 PMCID: PMC9145669 DOI: 10.3390/pharmaceutics14050956] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 02/04/2023] Open
Abstract
Nasal sprays, which produce relatively large pharmaceutical droplets and have high momentum, are primarily used to deliver locally acting drugs to the nasal mucosa. Depending on spray pump administration conditions and insertion angles, nasal sprays may interact with the nasal surface in ways that creates complex droplet–wall interactions followed by significant liquid motion after initial wall contact. Additionally, liquid motion can occur after deposition as the spray liquid moves in bulk along the nasal surface. It is difficult or impossible to capture these conditions with commonly used computational fluid dynamics (CFD) models of spray droplet transport that typically employ a deposit-on-touch boundary condition. Hence, an updated CFD framework with a new spray–wall interaction (SWI) model in tandem with a post-deposition liquid motion (PDLM) model was developed and applied to evaluate nasal spray delivery for Flonase and Flonase Sensimist products. For both nasal spray products, CFD revealed significant effects of the spray momentum on surface liquid motion, as well as motion of the surface film due to airflow generated shear stress and gravity. With Flonase, these factors substantially influenced the final resting place of the liquid. For Flonase Sensimist, anterior and posterior liquid movements were approximately balanced over time. As a result, comparisons with concurrent in vitro experimental results were substantially improved for Flonase compared with the traditional deposit-on-touch boundary condition. The new SWI-PDLM model highlights the dynamicenvironment that occurs when a nasal spray interacts with a nasal wall surface and can be used to better understand the delivery of current nasal spray products as well as to develop new nasal drug delivery strategies with improved regional targeting.
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Affiliation(s)
- Arun V. Kolanjiyil
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA; (A.V.K.); (A.A.); (G.A.); (L.G.)
| | - Ali Alfaifi
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA; (A.V.K.); (A.A.); (G.A.); (L.G.)
| | - Ghali Aladwani
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA; (A.V.K.); (A.A.); (G.A.); (L.G.)
| | - Laleh Golshahi
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA; (A.V.K.); (A.A.); (G.A.); (L.G.)
| | - Worth Longest
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA; (A.V.K.); (A.A.); (G.A.); (L.G.)
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA 23298, USA
- Correspondence:
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Chen J, Martin AR, Finlay WH. Recent In Vitro and In Silico Advances in the Understanding of Intranasal Drug Delivery. Curr Pharm Des 2021; 27:1482-1497. [PMID: 33183191 DOI: 10.2174/1381612826666201112143230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Many drugs are delivered intranasally for local or systemic effect, typically in the form of droplets or aerosols. Due to the high cost of in vivo studies, drug developers and researchers often turn to in vitro or in silico testing when first evaluating the behavior and properties of intranasal drug delivery devices and formulations. Recent advances in manufacturing and computer technologies have allowed for increasingly realistic and sophisticated in vitro and in silico reconstructions of the human nasal airways. OBJECTIVE The study aims to perform a summary of advances in the understanding of intranasal drug delivery based on recent in vitro and in silico studies. CONCLUSION The turbinates are a common target for local drug delivery applications, and while nasal sprays are able to reach this region, there is currently no broad consensus across the in vitro and in silico literature concerning optimal parameters for device design, formulation properties and patient technique which would maximize turbinate deposition. Nebulizers can more easily target the turbinates, but come with the disadvantage of significant lung deposition. Targeting of the olfactory region of the nasal cavity has been explored for the potential treatment of central nervous system conditions. Conventional intranasal devices, such as nasal sprays and nebulizers, deliver very little dose to the olfactory region. Recent progress in our understanding of intranasal delivery will be useful in the development of the next generation of intranasal drug delivery devices.
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Affiliation(s)
- John Chen
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, Canada
| | - Andrew R Martin
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, Canada
| | - Warren H Finlay
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, Canada
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Hussain AS, Morris K, Gurvich VJ. Pharmaceutical Quality, Team Science, and Education Themes: Observations and Commentary on a Remarkable AAPS PharmSciTech Theme Issue. AAPS PharmSciTech 2021; 22:88. [PMID: 33665776 PMCID: PMC7931785 DOI: 10.1208/s12249-021-01970-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 11/30/2022] Open
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In vitro - in vivo correlation of intranasal drug deposition. Adv Drug Deliv Rev 2021; 170:340-352. [PMID: 32918968 DOI: 10.1016/j.addr.2020.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 12/31/2022]
Abstract
In vitro - in vivo correlation (IVIVC) allows prediction of in vivo drug deposition from a nasally inhaled drug based on in vitro drug measurements. In vitro measurements include physical particle characterization and, more recently, deposition studies using anatomical models. Currently, there is a lack of IVIVC for deposition measurements in anatomical models, especially for deposition patterns in various nasal cavity regions. Therefore, improvement of in vitro and in vivo measurement methods and knowledge about nasal deposition mechanisms should help IVIVC in the future.
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Tai J, Lee K, Kim TH. Current Perspective on Nasal Delivery Systems for Chronic Rhinosinusitis. Pharmaceutics 2021; 13:246. [PMID: 33578812 PMCID: PMC7916625 DOI: 10.3390/pharmaceutics13020246] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/02/2021] [Accepted: 02/06/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic rhinosinusitis is an upper respiratory disease during which topical drug treatment via the nasal cavity is the most actively utilized therapeutic strategy. In addition to steroids, antibiotics, and antifungal agents, which are widely used in clinical practice, research on novel topical agents to improve the bacterial biofilm or mucociliary clearance remains ongoing. Moreover, owing to the complex structure of the nasal cavity, the effects of nasal drug delivery vary depending on factors related to delivery fluid dynamics, including device, volume, and compounds. In this article, we review methods and compounds that have been applied to chronic rhinosinusitis management and introduce recent advances and future perspectives in nasal drug delivery for upper respiratory diseases.
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Affiliation(s)
| | | | - Tae Hoon Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul 02841, Korea; (J.T.); (K.L.)
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Sosnowski TR, Rapiejko P, Sova J, Dobrowolska K. Impact of physicochemical properties of nasal spray products on drug deposition and transport in the pediatric nasal cavity model. Int J Pharm 2019; 574:118911. [PMID: 31809854 DOI: 10.1016/j.ijpharm.2019.118911] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 11/30/2022]
Abstract
The study is focused on the analysis of physicochemical properties of selected nasal sprays of mometasone furoate, and the influence of these properties on aerosol quality and penetration in the pediatric nose. After the determination of drugs surface tension and viscosity, spray geometry and size distribution of aerosol droplets, the topical delivery of each drug to different parts of the pediatric model of the nose with the flexible vestibule was evaluated by colorimetric visualization. All tested drugs are pseudo-plastic liquids, showing some differences in flow consistency constant k (range 714-1422) and flow behavior index n (range 0.16-0.31). At no-flow conditions, all sprays are deposited mainly in the anterior of the nasal cavity and the septum (2-3 cm from the nostril), as a result of inertial impaction of large droplets. The deposition range is slightly influenced by the geometry of the aerosol cloud, which, in turn, depends both on drug properties and the type of the spraying nozzle. Deposition experiments accompanied by the airflow show an enhancement of drug transport to deeper parts of the nasal cavity (up 4-6 cm from the vestibule), and this effect can be attributed to the secondary effects of spreading of the deposited liquid layer along the narrow air passages in the nose. Plume geometry, dose volume and rheological properties of the drug were shown to be important factors in the spray penetration pattern in the pediatric nose. The deepest delivery can be expected for drugs of low viscosity and short aerosol plumes.
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Affiliation(s)
- Tomasz R Sosnowski
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Waryńskiego 1, 00-645 Warsaw, Poland.
| | - Piotr Rapiejko
- Department of Otolaryngology with Division of Cranio-Maxillo-Facial Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Jarosław Sova
- Department of Otolaryngology, 7th Navy Hospital in Gdansk, Poland
| | - Katarzyna Dobrowolska
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Waryńskiego 1, 00-645 Warsaw, Poland
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