Intralesional

Parenteral drug administration means the giving of a drug by the subcutaneous (SC), intramuscular (IM), intravenous (IV), or intradermal route (Fig. 2-5). Other routes of parenteral administration that may be used by the primary care provider are intralesional (into a lesion), intra-arterial (into an artery), intracardiac (into the heart), and intra-articular (into a joint), hi some instances, intra-arterial dragp are administered by a nurse. However, administration is not by direct arterial injection but by means of a catheter that has been placed in an artery. 

The primary care provider may administer a drug by the intracardial, intralesional, intra-arterial, or intra-articular routes. The nurse may be responsible for preparing the drug for administration. The nurse should ask the primary care provider what special materials will be required for administration. 

Promoting an Optimal Response to Therapy The glucocorticoids may be administered orally, IM, SC, IV, topically, or as an inhalant. The primary health care provider may also inject the drag into a joint (intra-articular), a lesion (intralesional), soft tissue, or bursa The dosage of the drug is individualized and based on the severity of the condition and the patient s response. 

Other treatments may include fluorouracil/epinephrine/bovine collagen gel, an intralesional injection that has been proven effective in clinical trials for refractory patients, or an intralesional injection of interferon. 

In contrast, parenteral suspensions have relatively low solids contents, usually between 0.5 and 5%, with the exception of insoluble forms of penicillin in which concentrations of the antibiotic may exceed 30%. These sterile preparations are designed for intramuscular, intradermal, intralesional, intraarticular, or subcutaneous injection. Syringeability is an important factor to be taken into consideration with injectable dosage forms. The viscosity of a parenteral suspension should be sufficiently low to facilitate injection. Common suspending vehicles include preserved isotonic saline solution or a parenterally acceptable vegetable oil. Ophthalmic and optic suspensions that are instilled into the eye/ear must also be prepared in a sterile manner. The vehicles are essentially isotonic and aqueous in composition. The reader should refer to Chapter 12 for further discussion on parenteral products. 

Quint U, Muller RT, Muller G. 1998. Characteristics of phenol Instillation in intralesional tumor excision of shondroblastoma, osteoclastoma and enchondroma. Arch Orthop Trauma Surg 117 43-46. 

Hydrocortisone acetate - For intralesional, intra-articular, or soft tissue injection only. Not for IV use. Dosage range is 5 to 37.5 mg. If desired, a local anesthetic may be injected before hydrocortisone acetate or mixed in a syringe and given simultaneously. 

Intralesional, intra-articular, or soft tissue injection 4 mg, up to 100 mg. 

Intra-articular, intralesional, or soft tissue administration 8 to 30 mg. Doses greater than 40 mg are not recommended. 

Intralesional or sublesional Up to 0.5 mg per square inch of affected area. 

III.c.2.3. Daily dosages of IVIMMs with concomitant weekly polyarticular injections/intralesional infiltration (PA). 

Interferons a-2b (Intron-A), a-nl, and a-n3 (Alferon N) have both intrinsic antiviral effects and antiproliferative and immunomodulatory actions. These interferons are approved for intralesional therapy of refractory or recurrent condylomata (genital warts). Toxicities include flulike symptoms, nausea, depression of the white blood cell count, and mild diminution in hematocrit. 

Natural interferons produced by human leukocytes, recombinant interferons produced in bacteria, and recombinant interferons conjugated to monomethoxy polyethylene glycol (PEG pegylated interferons) are available in the United States. The various preparations may be administered subcutaneously, intramuscularly, intravenously, or intralesionally (e.g., into genital warts). Natural or recombinant interferons typically achieve peak plasma levels within 4 to 8 hours of subcutaneous... 

Flulike symptoms, including fever, chills, weakness, fatigue, myalgia, and arthralgia, are the most common side effects of interferon therapy. These symptoms occur in more than 50% of patients given injections of interferons either intravenously, intramuscularly, or subcutaneously. Intralesional injection may produce milder flulike symptoms with somewhat less frequency. Tolerance to these symptoms generally develops with repeated dosing. 

Condylomata acuminata Interferon alfa-2b-. Intralesional 1 million units/lesion 3 times/wk for 3 wk. Use only 10-million-unit vial, reconstitute with no more than 1 ml diluent. Use tuberculin (TB) syringe with 25-or 26-gauge needle. Give in evening with... 

Condyloma acuminatum Intralesional 0.05 ml (250,000 international units) per wart twice a week up to 8 wk. Maximum dose/treatment session 0.5 ml (2.5 million international units). Do not repeat for 3 mo after initial 8-wk course unless warts enlarge or new warts appear. 

Substitution therapy for deficiency states acute or chronic adrenal insufficiency, congenital adrenal hyperplasia, and adrenal insufficiency secondary to pituitary insufficiency, nonendocrine disorders arthritis rheumatic carditis allergic, collagen, intestinal tract, liver, ocular, renal, shin diseases bronchial asthma cerebral edema malignancies PO 5-60 mg/day in divided doses. Intra-articular, Intralesional (acetate) 4-100 mg, repeated as needed. Intra-articular, Intralesional (sodium phosphate) 2-30 mg, repeated at 3-day to 3-week intervals, as needed. IM (acetate, sodium phosphate) 4-60 mg a day. 

Brand Name(s) (Triamcinolone diacetate) Amcort. Aristocort Intralesional... 

Blindness has occurred rarely after intralesional injection around face and head. 

Fluorouracil, a fluorinated pyrimidine antimetabolite is used topically for the treatment of multiple actinic keratoses and intralesionally for keratoacanthomas. 

Route of admiiustration Intron A is intended for intramuscular, subcutaneous, intralesional, or intravenous injection. 

Interferons and cytokines Interferon alfa-2b, human recombinant product produced in E. coli Intron A Lyophilized 5, 10,18,25, or 50MIUvial IM,SC, IV, intralesional... 

Parenteral 4 mg/mLfor IV, IM, intralesional, or intra-articular injection Cortisone (generic, Cortone Acetate)... 

Parenteral 25, 50 mg/mL suspension for intralesional, soft tissue, or intra-articular injection Hydrocortisone cypionate (Cortef)... 

Parenteral 20 mg/mL for IV, IM, intra-articular, or intralesional injection Prednisone (generic, Meticorten)... 

Parenteral 5, 20 mg/mL for intra-articular, intralesional, or sublesional injection... 

Interferons have been studied for numerous clinical indications. In addition to HBV and HCV infections (see Antihepatitis Agents), intralesional injection of interferon alfa-2b or alfa-n3 may be used for treatment of condylomata acuminata (see Chapter 61). 

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