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Electrophoretic evaluation of the mobility of drugs suitable for iontophoresis.

Iontophoresis is the process of increasing the penetration of drugs for therapeutic purposes using DC electricity. The most important factor for iontophoresis is the formation of drug ions in solution. On this basis, the penetration of any drug applied by iontophoresis might be maximized at an optimal pH. Seven medications were investigated: acyclovir, methylprednisolone sodium succinate, metronidazole, dexamethasone sodium phosphate, minoxidil, lidocaine hydrochloride, and adenine arabinoside monophosphate. Using techniques of paper electrophoresis, we evaluated the influence of pH on the mobility (mu) of the drugs in phosphate buffers at pH 5, 7, and 9. The mu-values were calculated after detecting the drugs on paper with ultraviolet light. The results indicate that the seven drugs had higher mu-values usually at one, but sometimes at two, of the pH values studied. This study suggests that a variation in pH might alter the maximum ionization, and therefore, the optimal mobility for these seven drugs, as well as other drugs, suited to iontophoresis.

Electrophoresis, Paper↗

Ketoprofen tissue permeation in swine following cathodic iontophoresis.

BACKGROUND AND PURPOSE: Pharmacokinetic assessment of drug tissue permeation following iontophoresis is limited. The depth of ketoprofen tissue permeation following cathodic iontophoresis (4 mA, 40 minutes) and the stereoselectivity of drug delivery were examined in this study. SUBJECTS: Ketoprofen (750 mg) was iontophoresed onto one porcine medial thigh, with passive drug permeation conducted on the other thigh. METHODS: Skin, subcutaneous fascia, and muscle biopsies from the drug delivery sites were harvested and stored separately, and the "R" and "S" ketoprofen enantiomers were determined. Results. Iontophoretic and passive applications yielded equivalent total ketoprofen concentrations in the skin and fascia. In contrast, multivariate analysis demonstrated that the ketoprofen concentration in the first centimeter of muscle following iontophoresis was greater than the drug concentration in the deeper underlying muscle layers and greater than that delivered to any muscle layer following passive delivery. No transcutaneous stereoselective delivery) of ketoprofen was detected. CONCLUSION AND DISCUSSION: Compared with passive delivery, iontophoresis enhances nonstereoselective ketoprofen permeation into the fascia-muscle interface. With delivery to deeper tissue sites, however, there is no apparent enhancement over passive application.

Animals↗

Effects of iontophoresis and electroporation on the stratum corneum. Review of the biophysical studies.

This review focuses on the effects induced by iontophoresis and electroporation on the stratum corneum of the skin. Hence, the aims were: (1) to contribute to the understanding of the mechanisms of drug transport by these methods; (2) to evaluate the safety issues associated with current application. Complementary biophysical methods were used to provide a complete picture of the stratum corneum. Even though the mechanism of drug transport is believed to be different, i.e., electrophoresis for iontophoresis and creation of new aqueous pathways for electroporation, the effects on the stratum corneum detected minutes after current application are very similar. For both methods, the major findings were: (1) a disorganisation of the lipid bilayers of the stratum corneum; (2) an increase in skin hydration; (3) a larger decrease in skin resistance induced by electroporation as compared to iontophoresis. These changes were partly reversible and depended on the amount of electrical charges transferred. The mechanisms of stratum corneum perturbations are discussed. These perturbations could explain partly the increase in drug transport. If iontophoresis is considered as a safe method of drug delivery, the data augurs for the safety of electroporation.

Journal Article↗

Local and propagated dendritic action potentials evoked by glutamate iontophoresis on rat neocortical pyramidal neurons.

Iontophoresis of glutamate at sites on the apical dendrite 278-555 microm from the somata of rat neocortical pyramidal neurons evoked low-threshold, small, slow spikes and/or large, fast spikes in 71% of recorded cells. The amplitude of the small, slow spikes recorded at the soma averaged 9.1 mV, and their apparent threshold was <10 mV positive to resting potential. Both their amplitude and their apparent threshold decreased as the iontophoretic site was moved farther from the soma. These spikes were not abolished by somatic hyperpolarization. When the somata of cells displaying these small spikes were voltage clamped at membrane potentials that prevented somatic or axonic firing, corresponding current spikes could be evoked all-or-none by dendritic depolarization, indicating that the small, slow spikes arose in the dendrite. Similar responses were not observed during somatic depolarization evoked by current pulses or glutamate iontophoresis. These small, slow spikes were abolished by blocking voltage-gated Ca2+ channels but not by blocking Na+ channels or N-methyl-D-aspartate receptors. We conclude that these Ca2+ spikes occurred in a spatially restricted region of the dendrite and were not actively propagated to the soma. In the presence of 10 mM tetraethylammonium chloride, the amplitudes of the iontophoretically evoked Ca2+ spikes were large, similar to those of the Ca2+ spikes evoked by somatic current injection, but their apparent thresholds were 63% lower. We conclude that dendritic K+ channels normally prevent the active propagation of Ca2+ spikes along the dendrite. In 36% of recorded cells dendritic glutamate iontophoresis evoked a Na+ spike with an apparent threshold 63% lower than those evoked by somatic current injection or somatic glutamate iontophoresis. Blockade of these low-threshold Na+ spikes by pharmacological or electrophysiological means often revealed underlying small dendritic Ca2+ spikes. When cells displaying the low-threshold Na+ spikes were voltage clamped at membrane potentials that prevented firing of the soma or axon, corresponding tetrodotoxin-sensitive current spikes could be evoked all-or-none by dendritic depolarization. We conclude that these low-threshold Na+ spikes were initiated in the dendrite, probably by local Ca2+ spikes, and subsequently propagated actively to the soma. Most cells displaying dendritic Na+ spikes fired multiple bursts of action potentials during tonic dendritic depolarization, whereas somatic depolarization of the same cells evoked only regular firing. We discuss the implications of dendritic Ca2+ and Na+ spikes for synaptic integration and neural input-output relations.

Animals↗

A modified coaxial compound micropipette for extracellular iontophoresis and intracellular recording: fabrication, performance and theory.

Investigation of the identity and modes of action of neurotransmitters in the mammalian central nervous system can be facilitated by simultaneous intracellular recording of membrane potential and extracellular iontophoresis of agonists and antagonists. We describe here techniques for conveniently constructing a compound microelectrode, originally described by Sonnhof (Pflugers Arch 341, 351-358, 1973), suitable for such studies. The Sonnhof electrode consists of two components, a centraxial micropipette for recording membrane potential surrounded by a cylindrical array of 6 pipettes for iontophoresis. The cylindrical array tapers coaxially and terminates in 6 contiguous, crescent-shaped orifices surrounding the terminal portion of the central pipette, 25 - 50 microm from the tip. Pipettes were constructed from borosilicate glass tubing of 1-mm wall thickness having a 10-mm or 16-mm outer diameter. The resistances, flux and transport numbers for iontophoresis of glycine were measured for pipettes constructed from both sizes of glass. Flux increased with increasing levels of current, and transport number decreased with increasing micropipette resistance. A spherical diffusion model points out the steep dependence of steady state concentration on diffusional distance, stressing the importance of diminishing the distance between the iontophoresis source and the recording site. This is particularly true when brief pulses of current are used.

Animals↗

Treatment of palmar hyperhidrosis using tap water iontophoresis: local experience.

To evaluate the efficacy and safety of tap water iontophoresis in the treatment of severe idiopathic palmar hyperhidrosis, nine Chinese patients with severe palmar hyperhidrosis that had failed to respond to topical aluminium chloride were given 6 weeks' treatment with tap water iontophoresis at the Social Hygiene Service, Department of Health, Hong Kong. The reduction in sweat output was assessed objectively and subjectively. The mean objective reduction in sweat output was 49%, 51%, 26%, and 22% at week 3, 6, 10, and 12, respectively, since the start of treatment with tap water iontophoresis The mean subjective improvements were 43%, 59%, 30%, and 12% at week 3, 6,10, and 12, respectively. The side effects reported were all mild and transient. We conclude that tap water iontophoresis is a safe and useful treatment modality for palmar hyperhidrosis.

Journal Article↗

Transscleral iontophoresis as an adjunctive treatment for experimental endophthalmitis.

We examined the efficacy of transcleral iontophoresis as an adjunct to intravitreal injection in the treatment of experimental Pseudomonas endophthalmitis in rabbits. Animals received no antibacterial treatment (untreated controls; group 1), a single intravitreal injection of 100 micrograms of gentamicin sulfate (group 2), or the same dose of gentamicin sulfate along with two treatments of transscleral iontophoresis given 24 and 48 hours after the intravitreal injection (group 3). Treatment was initiated 16, 24, or 48 hours after the induction of infection. For each interval from infection to treatment, there was a lower bacterial count and a higher rate of sterilization in the eyes in group 3 than in group 2; both treated groups had better outcomes than the untreated controls. These data suggest that transscleral iontophoresis could be clinically useful as a supplement to intravitreal injection for a refractory type of endophthalmitis such as that caused by Pseudomonas aeruginosa.

Animals↗

Transtympanic iontophoresis of dexamethasone and fosfomycin.

The effects of transtympanic iontophoresis of corticosteroids and antibiotics on otitis media with effusion (OME) were investigated. An experimental study using guinea pigs revealed that transtympanic passage of dexamethasone sodium phosphate and fosfomycin sodium by iontophoresis had sufficient anti-inflammatory and antimicrobial effects. Twenty children with OME (33 ears) who were treated by iontophoresis were compared with 28 untreated children with OME (35 ears) with respect to improvement assessed by tympanoaudiometry. After one month, tympanoaudiometry revealed improvement in 21 (63.6%) of the treated ears but in only 13 (37.1%) of the untreated ears, indicating the efficacy of this treatment for OME.

Acoustic Impedance Tests↗

The efficacy of dexamethasone iontophoresis for the treatment of rheumatoid arthritic knees: a pilot study.

OBJECTIVE: To examine the efficacy of dexamethasone sodium phosphate (DEX) iontophoresis for the treatment of rheumatoid arthritis (RA) of the knee, and to obtain statistical information for a future randomized controlled trial (RCT). METHODS: Ten subjects with RA, ranging in age from 34-75, were randomly assigned to either the experimental or placebo group. Iontophoresis treatments were given to both groups on days 1, 3, and 5. Five subjects in the experimental group received a mixture of 1 ml of DEX (4 mg/ml) and 1 ml of injectable sterile water; those in the placebo group received 2 ml of saline solution. Pain on movement, at rest, and on pressure, active joint count, and active range of motion, were evaluated on days 1, 5, and 20. The patient's global assessment of treatment efficacy was also assessed on days 5 and 20. Mann-Whitney U tests and Friedman two-way analyses of variance were performed for statistical analyses. RESULTS: Pain at rest was found to be statistically different between the two groups (P = 0.0317). Statistical significance was also found over time for pain on movement within the experimental group (P = 0.0224). CONCLUSION: The results suggest that DEX iontophoresis is more effective than placebo in relieving pain at rest and on movement in the RA knee. Based on the study data, a total of 40 subjects will be required for an RCT of a similar nature.

Activities of Daily Living↗

Pharmacokinetic and local tissue disposition of [14C]sodium diclofenac following iontophoresis and systemic administration in rabbits.

The systemic pharmacokinetics and local drug distribution of sodium diclofenac in skin and underlying tissues was studied. Iontophoresis facilitated local and systemic delivery of diclofenac sodium compared with passive diffusion. The maximum plasma concentration of sodium diclofenac was achieved within 1 h of iontophoresis, and the delivery was proportional to applied current density (371 +/- 141 and 132 +/- 62 microg/L at 0.5 and 0.2 mA/cm(2), respectively). The in vivo delivery efficiency for diclofenac in rabbit was 0.15 mg/mA.h. The concentrations of sodium diclofenac in the skin, subcutaneous tissue, and muscle beneath the drug application site (cathode) were significantly greater than plasma concentrations and concentrations of drug in similar tissues at the untreated sites. The results thus suggest that the cutaneous microvasculature is not always a perfect "sink" and that transdermal iontophoresis facilitated the direct penetration of diclofenac sodium to deeper tissues. No skin irritation was observed up to 0.5 mA/cm(2) current density and 7 mg/mL sodium diclofenac concentration.

Animals↗

Effect of chemical enhancers and iontophoresis on thiocolchicoside permeation across rabbit and human skin in vitro.

The aim of this work was to study the permeation of thiocolchicoside across the skin in vitro. The effect of the chemical enhancer lauric acid and the physical technique of iontophoresis was investigated. Permeation experiments were performed in vitro using rabbit ear skin as barrier. The effect of lauric acid at different concentrations (2% and 4%) and of the vehicle (water, ethanol, or ethanol/water) was investigated. The primary effect of lauric acid was on the partitioning parameter, whereas the diffusive parameter did not change significantly. When human epidermis was used, the permeation parameters were generally lower, although not significantly different from rabbit ear skin. The data obtained with full-thickness human skin indicate that, despite the hydrophilic nature of thiocolchicoside, the resistance to drug transport is not limited to the stratum corneum, but that the underlying dermal tissue can also contribute. Iontophoresis enhanced the flux of thiocolchicoside compared with the passive control. The mechanism by which iontophoresis enhanced thiocolchicoside transport across the skin was electroosmosis. The permeation of thiocolchicoside across the skin can be enhanced using chemical or physical penetration enhancers.

Adjuvants, Pharmaceutic↗

Characterization of the permselective properties of excised human skin during iontophoresis.

The iontophoretic and passive transport of [3H]mannitol, 22Na+, 36Cl-, and 45Ca++ across excised human cadaver skin was studied using diffusion cells. The anode (+) was placed in the side of the diffusion cell facing the epidermis and the cathode (-) was placed in the side facing the dermis, and current densities at 0, 0.078, 0.16, and 0.23 mA.cm-2 were investigated. The results showed that mannitol and Na+ were transported preferentially by anodal (+) iontophoresis, Cl- was transported by cathodal (-) iontophoresis, and all respective fluxes were approximately proportional to the applied current density. When the skin was present as a membrane barrier between the two diffusion cell chambers the voltage induced flux of Na+ was found to be higher than its free solution value, and that of Cl- was lower. Taken together these results suggest that the skin is a permselective membrane and exists with an "apparent" net negative charge at the free solution pH of 7.4. During iontophoresis this permselectivity leads to current-induced volume flow, which provides a primary mechanism for the transport for a polar uncharged molecule such as mannitol. When Ca++ is substituted for Na+ on the side of the diffusion cell facing the epidermis, the Cl- flux from the dermal side is enhanced with a portion of the remaining charge being carried by Ca++. The mannitol flux from the epidermal side was decreased under these conditions. This implies that Ca++ alters the anion/cation flux ratio in the excised tissue, possibly by binding to fixed negative charges in the membrane, with the result that the volume flow is decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Iontophoresis of polypeptides: effect of ethanol pretreatment of human skin.

This paper explores the possibility of iontophoretically enhancing the in vitro transdermal flux of two polypeptides: leuprolide (a LHRH analogue; MW = 1209.4) and a cholecystokinin-8 analogue (CCK-8; MW = 1150.17). Control experiments at an applied voltage of 0.5 V across full-thickness human skin did not yield measurable fluxes of either polypeptide, suggesting that despite the expected iontophoretic flux enhancements, the intrinsic permeability of these polypeptides through skin may be too low to allow significant amounts of the drug to permeate. Therefore, pretreatment with ethanol (to simulate the effect of a chemical permeation enhancer) followed by iontophoresis was investigated with the aim of evaluating the potential of the enhancer plus ionophoresis as a means for controlled transdermal delivery of these polypeptides. The ethanol pretreatment dramatically increased the passive fluxes of both polypeptides, and iontophoresis produced further enhancements in their fluxes. Also, the experimental enhancement factors for leuprolide as a function of the applied voltage appeared to be generally lower than the predictions of the constant field theory. A synergism of iontophoresis with a chemical permeation enhancer may be a potential route for controlled transdermal delivery of these and other high molecular weight polypeptides.

Ethanol↗

Effects of vasoactive drugs on transdermal lidocaine iontophoresis.

The effect of co-administration of vasoactive drugs on the transdermal iontophoretic delivery of lidocaine.HCI was studied in in vitro cells, in the isolated perfused porcine skin flap (IPPSF), and in vivo in pigs. Iontophoresis of lidocaine in vitro across human and porcine skin were similar, supporting the use of porcine skin as an appropriate animal model. Co-iontophoresis of the vasodilator tolazoline marginally decreased lidocaine flux in vitro, but significantly increased it in the IPPSF and in vivo. In contrast, norepinephrine decreased lidocaine flux in the IPPSF. Vasomodulation also changed the shape of the venous efflux profile in the IPPSF as evidenced by changes in fractional absorption index, as well as the AUC. These studies demonstrate that co-iontophoresis of vasoactive compounds may significantly alter the transdermal delivery of lidocaine and that use of vitro animal model systems which possess a functional microcirculation are essential to study this process if reliable extrapolation to the in vivo setting is desired.

Administration, Cutaneous↗

Effect of iontophoresis on in vitro skin permeation of an analogue of growth hormone releasing factor in the hairless guinea pig model.

The shortened analogue of growth hormone releasing factor (GRF) Ro 23-7861 (1) has a molecular weight of 3929 daltons [equivalent to GRF (1-29)] and is more potent than the endogenous GRF (1-44). The in vitro hairless guinea pig model and vertical and horizontal diffusion cell assemblies were used to study the effect of iontophoresis on the permeability to skin of 1. The transport of 1 across the skin was studied by monitoring the rate of its appearance in the receiver compartment with a radioimmunoassay. No permeability of 1 was observed without iontophoresis, whereas with iontophoresis, the permeability of 1 was significant. For example, at a current density of 0.23 mA/cm2 and buffer concentration of 0.05 M, the flux of 1 was 56.8 +/- 8.21 ng/cm2.h. The flux of 1 was independent of the design of the permeation apparatus, the electrodes, the donor and receiver volumes, the type of current (constant or pulsed), and the frequency of the pulsed current. The flux of 1 increased curvilinearly with the increase in salt concentration of the buffer and linearly with the increase in current.

Algorithms↗

Lidocaine iontophoresis mediates analgesia in lateral epicondylalgia treatment.

BACKGROUND AND PURPOSE: Iontophoresis transcutaneously delivers anti-inflammatory and analgesic drugs for the treatment of musculoskeletal dysfunction. Lidocaine is a local anaesthetic with analgesic but no anti-inflammatory properties. The purpose of this investigation was to examine the clinical use of lidocaine iontophoresis-mediated analgesia in a larger treatment algorithm for five patients with lateral humeral epicondylalgia. METHOD: The investigation was a case series design of five subjects, aged 52 (+/- 6) years, with epicondylalgia of 12-393 days' duration. At each treatment session, the patients received cryotherapy, cross-fibre massage and passive stretch. Between sessions analgesia was provided by an 80 mA-min low-current, long-duration lidocaine iontophoresis (LI) over a 24-hour period. Patients were treated on an every-other-day basis for a total of three treatment sessions. Clinical improvements were determined by triplicate measurements of dolorimetric force over the affected epicondyle prior to treatment 1 (baseline), prior to sessions 2 and 3, and one week following the last session. RESULTS: Patients demonstrated an increasing tolerance to dolorimetric force application prior to the next session. The force values prior to session 2 (3.1 (+/- 1.1) Newton (N)) and one week following the third session (3.4 (+/- 0.5) N) were significantly improved from the baseline values (2.1 (+/- 0.9) N). CONCLUSIONS: Pain associated with lateral epicondylalgia decreased, and function improved in all patients at the final measurement. One patient returned during the 90-day follow-up period to seek additional medical attention. This investigation documents the potential for analgesia provided by LI in the rehabilitation process of musculoskeletal dysfunction.

Algorithms↗

Iontophoresis of dexamethasone in the treatment of endotoxin-induced-uveitis in rats.

The purpose of this study was to evaluate the efficacy of a Coulomb Controlled Iontophoresis system (CCI) in the local delivery of corticosteroids for the treatment of uveitis. The therapeutic efficacy of Dexamethasone (Dex) administered by CCI was compared to systemic injection and to topical application with the iontophoresis apparatus in the absence of electrical current. The evaluation was done in the treatment of the endotoxin-induced uveitis (EIU) model, and in the effect on TNF gene expression in the iris/ciliary body as well as in the retina and on TNF levels in aqueous humor and vitreous. Dex was administered either at the time of LPS injection or 5 hours later. For iontophoresis, we used a 1 ml reservoir-electrode covering the cornea, the limbus, and the first millimeter of the sclera. The applied electrical current was of 400 microA during four minutes with a total surface charge of 0.4 C cm-2. EIU was evaluated by clinical examination, by counts of intraocular inflammatory cells on histological sections, and by measuring the protein levels in the aqueous humor and in the vitreous. The TNF-alpha gene expression in the iris and ciliary body, and in the retina was evaluated by RT-PCR. The systemic effect of Dex delivered by CCI was evaluated on the level of serum TNF-alpha in EIU. Our results demonstrated that local administration of Dex by CCI inhibited anterior and posterior signs of intraocular inflammation as effectively as systemic administration, with no effect on systemic level of TNF. In the anterior and posterior segments of the eye, the protein exudation. TNF levels and the cellular infiltration were inhibited. The TNF-alpha gene expression was inhibited in the anterior as well as the posterior segment of the eye. No clinical nor histological damage were caused by the CCI apparatus. In conclusion, CCI administration of Dex allows for a therapeutic effect on the posterior as well as the anterior segment of the eye, and may present a viable alternative to systemic administration of glucocorticoids in severe ocular inflammations.

Animals↗

The effect of iontophoresis on the cutaneous vasculature: evidence for current-induced hyperemia.

Combining laser-Doppler blood flux measurements of the skin microcirculation with iontophoresis of vasoactive agents is a promising noninvasive tool for pharmacological studies. However, preliminary observations in our laboratories suggested significant current-associated vasodilation when an expected vasoconstrictor (NG-monomethyl-L-arginine acetate) was iontophoresed. The present study was designed to define nonspecific current-related versus specific pharmacological effects of iontophoretically administered ions on the cutaneous vasculature. Dose-response studies to a series of anions (nitrite, chloride, acetate, and bicarbonate) and cations (sodium, lithium, and acetylcholine) were carried out in six healthy volunteers (three male) by iontophoresis to the forearm skin on separate days. Laser-Doppler flux was measured at the same sites. All ions caused dose-dependent vasodilation. There was no difference in the response between chloride, bicarbonate, or acetate and nitrite, the nitric oxide donor. The acetylcholine dose response was shifted rightward after atropine pretreatment. Cutaneous vascular responses to iontophoresis comprise nonspecific, current-induced hyperemia and specific effects of the administered agent. Acetylcholine appears to cause muscarinic and current-induced dilatation. Nitrite may cause current-induced hyperemia alone. Current-induced hyperemia should be considered in interpreting the acute cutaneous vascular responses to iontophoretically administered agents in humans.

Adult↗