Continuous subcutaneous infusion

Pulmonary arterial hypertension Continuous Subcutaneous Infusion, IV Infusion... 

Lepore, M., S. Pampanelli, C. FanelU, F. Forcellati, L. Bartocci, A. Di Vincenzo, C. Cordoni, E. Costa, P. Brunetti, and G.B. Bolli, Pharmacokinetics and pharmacodynamics of subcutaneous injection of long-acting human insulin analog glargine, NPH insulin, and ultralente human insulin and continuous subcutaneous infusion of insulin lispro. Diabetes, 2000. 49(12) 2142-8. 

Toft-Nielsen MB, Madsbad S, Holst JJ Continuous subcutaneous infusion of glucagon-like peptide 1 lowers plasma glucose and reduces appetite in type 2 diabetic patients. Diabetes Care 1999 22 1137. [PMID 10388979]... 

During continuous subcutaneous infusion of exenatide at different doses in 12 patients with type 2 diabetes nausea was the most common adverse effect (13). The dose of exenatide appears to be important. In a placebo-... 

Insulin resistance has been reported with continuous subcutaneous infusion. 

Diabetes mellitus in a 36-year-old man with acute pancreatitis could not be controlled with continuous subcutaneous insulin infusion, even with doses up to 1800 U/ day, because of insulin resistance (168). Intravenous insulin by pump had to be stopped because of a catheter infection. The continuous subcutaneous infusion of freeze-dried insulin and the addition of aprotinin, a protease inhibitor, soluble dexamethasone or prednisolone, and intravenous immunoglobulin was ineffective. An implantable pump for intraperitoneal delivery established good regulation at a dosage of 30 U/day. 

A 56-year-old man was given a continuous subcutaneous insulin infusion because of frequent episodes of hypoglycemia of which he was unaware and he had four separate episodes of profound ketoacidosis (194). Multiple daily injections produced less flexibility in his mealtimes, more episodes of hypoglycemia, and the need for more injections. However, injecting 60% of his basal needs as insulin glargine once daily in combination with continuous subcutaneous infusion prevented further episodes of diabetic ketoacidosis. 

Insulin aspart has been compared with buffered regular insulin by continuous subcutaneous infusion (9). There was some crystal formation with both formulations, but less with insulin aspart. Patients who used aspart required a slightly higher basal dose of insulin but had fewer unexplained attacks of hypoglycemia. 

Insulin glargine did not cause a peak in blood insulin concentration, compared with protamine zinc insulin and crystalline insulin zinc suspension (ultralente) the effect lasted 24 hours, almost comparable to continuous subcutaneous infusion of a short-acting insulin (15). 

Insulin lispro by repeated injection has been compared with insulin lispro by continuous subcutaneous infusion in 41 patients who were C-peptide negative (48). HbAic, mean blood glucose concentrations, and mean insulin doses were significantly lower during continuous subcutaneous infusion the frequency of attacks of hypoglycemia was the same. 

Prostacyclin lowers peripheral, pulmonary, and coronary resistance. It has been used to treat both primary pulmonary hypertension and secondary pulmonary hypertension, which sometimes occurs after mitral valve surgery. A commercial preparation of prostacyclin (epoprostenol) is approved for treatment of primary pulmonary hypertension, in which it appears to improve symptoms and prolong survival. However, because of its extremely short plasma half-life, the drug must be administered as a continuous intravenous infusion through a central line. Several prostacyclin analogs with longer half-lives have been developed and treprostinil was recently approved for use in pulmonary hypertension (Horn, 2002). This drug is administered by continuous subcutaneous infusion. 

However, it requires continuous subcutaneous infusion to produce a sustained lowering of both fasting and postprandial hyperglycemia in type 2 diabetic patients therefore, its clinical usefulness is limited. 

Continuous subcutaneous infusion of apomorphine can transform the quality of life of yoimger patients with severe motor fluctuations and dyskinesia, but this may lead to neuropsychiatric effects. If drug treatment fails in yormg non-demented patients, stereotactic subthalamotomy or bilateral stereotactic subthalamic stimulation can be very successful with only a small risk of surgical complications in experienced hands. Some 20% of patients with Parkinson s disease, notable the older ones, develop impairment of memory and speech with a fluctuating confusional state and hallucinations. As these symptoms are often aggravated by medication, it is... 

In a comparison of hydromorphone and morphine delivered by continuous subcutaneous infusion in 74 patients with severe cancer pain, the number of adverse effects was small and comparable in both groups (3). 

Another remotely activated device has been described by Groning et al. (57). They demonstrated in a model the remote control of a device to delivery insulin (Fig. 7). This possibility of external programming and monitoring of insulin pumps is possible for continuous subcutaneous infusion. The use of SMS allows immediate transfer of commands to the pump. There are many pitfalls to overcome the ethics of taking control away from the patients and their carer is but one, and there are safety issues, should the GPS system fad, and presumably if in error the pump is activated by the physician or indeed by individuals accidentally. But there is no doubt that telepharmacy wiU impact on future medicine, whether personalized or not. The personal element could come simply as a result of automated reminders to patients to take their medications also discussed above, but the more sophisticated systems described by Groning et al. wiU also have their place. 

Several clinical trials using Genasense (G3139, a PS DNA ASO targeting the anti-apoptotic protein Bcl-2) have included detailed PK analyses. One of the earliest trials of G3139 used a 14-day continuous subcutaneous infusion at doses ranging... 

Raynaud F I, Orr R M, et al. (1997). Pharmacokinetics of G3139, a phosphorothioate oligodeoxynucleotide antisense to bcl-2, after intravenous adminis-tration or continuous subcutaneous infusion to mice. J. Pharmacol. Exp. Ther. 281 420-427. 

Treprostinil (Fig. 29.13) is a synthetic, stable form of prostacyclin for the treatment for advanced pulmonary hypertension with NYHA class III or IV symptoms as well as for late-stage peripheral vascular disease (PVD). Its sodium salt injectable form is administered either as a continuous subcutaneous infusion directly into the skin or, if the subcutaneous infusion is not tolerated, as a continuous IV infusion without an implanted catheter. Treprostinil is rapidly absorbed from the subcutaneous site of infusion, with an almost 100% bioavailability and a mean half-life of 85 minutes (34 minutes for the IV infusion). The IV solution must be diluted with normal saline or sterile water before starting the infusion. Unlike epoprostenol, treprostinil is stable at room temperature for up to 5 years, with vasodilation action lasting from 4 to 6 hours, compared with the short, 2- to 3-minute action for epoprostenol. Because of its long life in the body, it can be administered under the skin with a microinfusion subcutaneous infusion pump rather than into the bloodstream and, thus, without hospitalization, as contrasted with the central IV infusion of epoprostenol. 

Champion, M. C., Shepherd, G. A., Rodger, N. W., and Dupre J., 1980. Continuous subcutaneous infusion of insulin in the management of diabetes mellitus. Diabetes 29 206-212. 

Pietri, A., and Raskin, P., 1981, Cutaneous complications of chronic continuous subcutaneous infusion therapy. Diabetes Care 4 624-626. 

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