The transdermal formulation offers the following advantages:
- Does not require oral intake (especially useful in patients with dysphagia and NPO status)
- Does not depend on GI absorption
- Improved patient compliance
- Less frequent dosing
- Long steady state with less peaks and troughs
- Intravenous access is not required
- Transdermal administration is not associated with patient discomfort
The disadvantages of the transdermal route include:
- Lack of efficacy for breakthrough pain given long steady state
- Difficulty delivering high doses
- Requires subcutaneous fat making it ineffective in cachectic patients
- Pharmacokinetics and pharmacodynamics are affected by body temperature (and blood flow to the skin) - Higher levels than expected may be absorbed during a febrile episode.
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