An ovarian cancer blog which includes quality resource materials: education, research, social networking, genetics and (some) healthcare politics.
“Not everything that can be counted counts and not everything that counts can be counted.”
Albert Einstein
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The nasal mucosa is highly vascularized AND it offers a direct path to the CSF via the olfacteory mucosa (nose-brain path). Any molecule that can cross the buccal or subligual mucosa will likely result in higher and faster CSF and blood levels if given via the nose (with an appropriate delivery device to ensure good mucosal coverage - not just dripping it in). Furthermore it works even in patients that have no saliva and who cannot swallow and it is easy tio deliver. Fentanyl is highly lipophilic and rapidly crosses into the body via the nose - the generic formulation is a little dilute for adults but is fantastic and cheap for treating pain in kids and some adults (see www.intranasal.net). Sufentanil generic formulation is well concentrated for adult cancer pain control (see data by Good et al). It is only a matter of time before clinicians recognize the nasal path as a simple, cost effective, very rapid route to treat breakthrough pain.
ReplyDeleteContraindicated for those cancer patients undergoing angiogenesis treatments specifically Avastin (Bevacizumab) - other exceptions?
ReplyDelete
The nasal mucosa is highly vascularized AND it offers a direct path to the CSF via the olfacteory mucosa (nose-brain path). Any molecule that can cross the buccal or subligual mucosa will likely result in higher and faster CSF and blood levels if given via the nose (with an appropriate delivery device to ensure good mucosal coverage - not just dripping it in). Furthermore it works even in patients that have no saliva and who cannot swallow and it is easy tio deliver. Fentanyl is highly lipophilic and rapidly crosses into the body via the nose - the generic formulation is a little dilute for adults but is fantastic and cheap for treating pain in kids and some adults (see www.intranasal.net). Sufentanil generic formulation is well concentrated for adult cancer pain control (see data by Good et al). It is only a matter of time before clinicians recognize the nasal path as a simple, cost effective, very rapid route to treat breakthrough pain.
ReplyDeleteContraindicated for those cancer patients undergoing angiogenesis treatments specifically Avastin (Bevacizumab) - other exceptions?
ReplyDelete