Can Ondansetron Be Administered Transdermally?
Can Ondansetron Be Administered Transdermally?
Pediatricians in our community have been asking local pharmacists to compound various medications using "Phlojel." Most recently, the trend has been to compound ondansetron, and they claim great success with it. I cannot find any articles to that effect, though; do you know of any evidence to support this treatment?
Joanna M. Pangilinan, PharmD
Pharmacist, Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan
Ondansetron is an antiemetic indicated for prevention of nausea and vomiting associated with chemotherapy, radiotherapy, and surgery. It is currently not available in a transdermal preparation; however, transdermal delivery has been studied using human, mouse, and snake skin.
Transdermal delivery of medications has several benefits. For instance, first-pass metabolism and stomach degradation can be avoided, and consistent plasma levels can be maintained. In addition, topical administration can deliver medication when oral intake is limited due to nausea and vomiting. Transdermal drug delivery is of particular interest for pediatric patients, who may have difficulties caused by frequency of medication administration, adverse taste, possibility of incomplete intake, and fear of needles.
Pluronic lecithin organogel (PLO) is a vehicle used in the compounding of transdermal preparations. PLO is usually composed of isopropyl palmitate, soy lecithin, water, and Pluronic F-127, a copolymer. Because PLO contains both a water and an oil phase, hydrophilic and lipophilic drugs may be used with it. Phlojel (JAR Pharmaceuticals, Edmonton, Alberta, Canada) is a commercially available PLO product used by compounding pharmacies in the preparation of transdermal products. Compounding instructions for ondansetron 8 mg/mL in PLO are explained in the International Journal of Pharmaceutical Compounding. Dosing, safety, and efficacy are not described.
Human trial data are limited for ondansetron given transdermally using PLO. In one study, topical ondansetron using a PLO vehicle was investigated in 12 patients. Doses of 100-250 mcg were found to have analgesic activity and to decrease mechanical hyperalgesia associated with capsaicin-induced pain. Ondansetron 250 mcg decreased the inflammatory flare associated with capsaicin. However, this trial was designed to measure local effects of ondansetron, not to evaluate emesis control or to measure systemic absorption.
Topical ondansetron is an attractive method of delivery and is currently under investigation. However, little evidence exists to support the efficacy of transdermal ondansetron in PLO, suggesting that most experience with this practice is anecdotal. In addition, no guidelines have been published for transdermal ondansetron use in pediatric patients.
Question
Pediatricians in our community have been asking local pharmacists to compound various medications using "Phlojel." Most recently, the trend has been to compound ondansetron, and they claim great success with it. I cannot find any articles to that effect, though; do you know of any evidence to support this treatment?
Response From the Expert
Joanna M. Pangilinan, PharmD
Pharmacist, Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan
Ondansetron is an antiemetic indicated for prevention of nausea and vomiting associated with chemotherapy, radiotherapy, and surgery. It is currently not available in a transdermal preparation; however, transdermal delivery has been studied using human, mouse, and snake skin.
Transdermal delivery of medications has several benefits. For instance, first-pass metabolism and stomach degradation can be avoided, and consistent plasma levels can be maintained. In addition, topical administration can deliver medication when oral intake is limited due to nausea and vomiting. Transdermal drug delivery is of particular interest for pediatric patients, who may have difficulties caused by frequency of medication administration, adverse taste, possibility of incomplete intake, and fear of needles.
Pluronic lecithin organogel (PLO) is a vehicle used in the compounding of transdermal preparations. PLO is usually composed of isopropyl palmitate, soy lecithin, water, and Pluronic F-127, a copolymer. Because PLO contains both a water and an oil phase, hydrophilic and lipophilic drugs may be used with it. Phlojel (JAR Pharmaceuticals, Edmonton, Alberta, Canada) is a commercially available PLO product used by compounding pharmacies in the preparation of transdermal products. Compounding instructions for ondansetron 8 mg/mL in PLO are explained in the International Journal of Pharmaceutical Compounding. Dosing, safety, and efficacy are not described.
Human trial data are limited for ondansetron given transdermally using PLO. In one study, topical ondansetron using a PLO vehicle was investigated in 12 patients. Doses of 100-250 mcg were found to have analgesic activity and to decrease mechanical hyperalgesia associated with capsaicin-induced pain. Ondansetron 250 mcg decreased the inflammatory flare associated with capsaicin. However, this trial was designed to measure local effects of ondansetron, not to evaluate emesis control or to measure systemic absorption.
Topical ondansetron is an attractive method of delivery and is currently under investigation. However, little evidence exists to support the efficacy of transdermal ondansetron in PLO, suggesting that most experience with this practice is anecdotal. In addition, no guidelines have been published for transdermal ondansetron use in pediatric patients.
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