To Iontophorise or not to Iontophorise? That is the question
Holler to the blogosphere! After previously
discussing the history, dosage and safety topics, the literature that has
evaluated iontophoresis must now be reviewed. The pros and cons will be
discussed from a range of papers on iontophoretic drug delivery.
For
First we will look at the merits of iontophoresis.
The fact that it is a non-invasive technique is beneficial in terms of patients
that are trypanophobic (have a phobia of needles) and need their analgesic
delivered to treat the source of pain. Several papers compared Iontophoresis to
traditional transdermal delivery system (TDDS) without electrical stimulation. Bodde,
Verhoef & Ponec (1989) measured the half-life of a
peptide drug in plasma and in the dermis and epidermis. The study showed that
the half-life of the drug was significantly longer in the epidermis and dermis
than in plasma. Therefore by enhancing the flux through iontophoresis there
will be increased drug delivery and the bioavailability of the drug will be
higher. The use of the electrical gradient instead of the chemical gradient to
drive the flux across the stratum corneum also has its merits according to the
same study. The chemical gradient requires higher concentrations of the drug to
create a stronger gradient. This is in contrast to iontophoresis that can
deliver smaller quantities just as fast but without the side effects that may
occur with overdosing of the drug. Bodde et al. (1989) also found that the
absorption rate of drugs varied without current application (due to changes in
the concentration gradient over time) but this variation did not occur in
iontophoresis. The faster diffusion rate of ionized drugs with iontophoresis
when compared to TDDS (limited by the chemical gradient) was supported by Srinivasan,
Higuchi, Sims, Ghanem & Behl (1989).
Against
Iontophoresis obviously has some great
advantages on other drug delivery systems, however there is literature that
highlights the limitations of this technique. Sanderson, de Riel
& Dixon (1989) brings to light that iontophoresis
may be a good system for applications requiring a short period of drug
delivery, but has unwanted side effects for applications requiring continuous
or long time periods of delivery. These effects were examined in the study of Singh,
Gross, Sage, Davis & Maibach (2000), which observed skin irritation in all
subjects from four ethnic groups who were treated with saline iontophoresis for
four hours. In the Moliton
& Fernandez (1939) review of iontophoresis, burns
caused by iontophoresis are discussed. However, this is only when a DC current
is applied. In this situation hydrogen ions build up in the anode whilst
hydroxide ions accumulate in the cathode causing pH changes that lead to
electrochemical burns (Howard, Drake & Kellogg, 1995). Howard et al. hypothesized that when an alternating current is
applied, hydrogen ions and hydroxide ions will be generated at alternate
phases, avoiding the pH change which causes skin burns. Howard’s study observed
that no burns occurred on patients for a two or four hour treatment time, so
burns need not be caused by iontophoresis. There have been related reports of
pain due to iontophoresis mentioned in literature (Khan et al., 2011) but there
is no evidence to support these claims.
As you can see, iontophoresis has
significant evidence to suggest it is a safe, viable method of drug delivery in
situations requiring brief treatment times.
Until next time, you stay classy planet
Earth.
References
Singh, J., Gross,
M., Sage, B., Davis, H. & Maibach, H. (2000). Effect of saline
iontophoresis on skin barrier function and cutaneous irritation in four ethnic
groups. Food Chem Toxiology, 38(8),
717-726.
Khan, A., Yasir, M., Asif, M., Chauhan, I.,
Singh, A., Sharma, R., Singh, P. & Rai, S. (2011). Iontophoretic drug
delivery: History and applications. Journal
of Applied Pharmaceutical Science, 1(3), 11-14.
Bodde, H., Verhoef, J. & Ponec, M. (1989).
Transdermal Peptide Delivery. Biochemical
Society Transactions, 17(5), 943-945.
Srinivasan, V., Higuchi, W., Sims, S., Ghanem,
A. & Behl, C. (1989). Transdermal iontophoretic drug delivery:
mechanistic analysis and application to polypeptide delivery. Journal of Pharmaceutical Science, 78(5),
370-375.
Sanderson, J., de Riel, S. & Dixon, R.
(1989). Iontophoretic delivery of nonpeptide drugs: formulation optimization
for maximum skin permeability. Journal of
Pharmaceutical Science, 78(5), 361-364.
Howard, J., Drake, T. & Kellogg, D.
(1995). Effects of Alternating Current Iontophoresis on Drug Delivery. Archives of Physical Medicine and
Rehabilitation, 76(1), 463-466.
Moliton,
H. & Fernandez, L. (1939). Experimental studies on the causes and
prevention of iontophoretic burns. The
American Journal of the Medical Sciences, 198(6), 778-784.
Nice work thanks - CY
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