Intrathecal route

Most injections are formulated as aqueous solutions, with Water for Injections BP as the vehicle. The formulation of injections depends upon several factors, namely the aqueous solubility of the active ingredient, the dose to be employed, thermal stability of the solution, the route of injection and whether the product is to be prepared as a multidose one (i.e. with a dose or doses removed on different occasions) or in a singledose form (as the term suggests, only one dose is contained in the injection). Nowadays, most injections are prepared as single-dose forms and this is mandatory for certain routes, e.g. spinal injections such as the intrathecal route and large-volume intravenous infusions (section 2.2). Multidose injections may require the inclusion of a suitable... 

The intrathecal route is employed to administer a drug directly into the cerebrospinal fluid at any level of... 

Incidents of vincristine overdosage have been reported relatively frequently in the medical literature. Some of these have involved inadvertent administration of the intravenous formulation into the central nervous system by the intrathecal route this produces devastating results by a combination of chemical damage to sensitive neuronal tissue as well as biochemical perturbations. Two representative cases of vincristine overdose were described (46) involving administration of vincristine to patients scheduled to receive vinblastine. In one patient toxicity initially involved vomiting and diarrhea with subsequent constipation and paralytic ileus (inhibition of motor activity in the small intestine). Muscle pain... 

The data in Table 8.4 have been extracted from an investigation reported by Miranda-FiUio et al who compared the treatment of tetanus by the intrathecal route with the standard intramuscular route. The primary endpoints of the study were disease progression and death and we concentrate here on the former. 

Any inferences about the difference between the effects of the two treatments that may be made upon such data are the observed rates, or proportions of deteriorations by the intrathecal route. In this example, amongst those treated by the intrathecal route 22/58 = 0.379 of patients deteriorated, and the corresponding control rate is 37/60 = 0.617. The observed rates are estimates of the population incidence rates, jtt for the test treatment and Jtc for the controls. Any representation of differences between the treatments will be based upon these population rates and the estimated measure of the treatment effect will be reported with an associated 95% confidence interval and/or p-value. 

Astromorph PF, Duramorph, Infumorph - Because of the risk of severe adverse effects when the epidural or intrathecal route of administration is employed, patients must be observed in a fully equipped and staffed environment for at least 24 hours after the initial dose. 

Intrathecal Management of severe spasticity of spinal cord origin in patients who are unresponsive to oral baclofen therapy or experience intolerable CNS side effects at effective doses. Intended for use by the intrathecal route in single bolus test doses (via spinal catheter or lumbar puncture) and, for chronic use, only in implantable pumps approved by the FDA specifically for the administration of baclofen into the intrathecal space. 

Intrathecal Administer undiluted solution by various intrathecal routes (20 mg/dose) as an adjunct to IV treatment in fungal meningitis. Succeeding intrathecal injections may be alternated between lumbar, cervical, and cisternal punctures every 3 to 7 days. 

Dosages and routes of administration Diamorphine is given by the oral as well as by parenteral (i.m., s.c) or intrathecal routes. Diamorphine is about twice as potent as morphine. The parenteral doses are 5-10 mg every 4 h, oral doses are up to two-fold higher. 

Grass, J.A. Sufentanil clinical use as postoperative analgesic - epidural/intrathecal route, J. Pain Symptom. Manage. 1992, 7, 271-286. 

Route of Administration. An application for a change in the route of administration, such as a change from an intravenous to intrathecal route. 

When an opioid is used as the sole agent by the epidural or intrathecal route, the results are disappointing, because of unwanted adverse effects, such as pruritus, nausea, vomiting, respiratory depression, and effects on the neonate, caused by significant systemic absorption (SEDA-17, 85). Hypotension and changes in fetal heart rate are not uncommon (SEDA-21, 91). Combinations of opioids (alfentanil, fentanyl, morphine, sufentanil) with local anesthetics (for example bupivacaine) have therefore been suggested to yield better results (SEDA-18, 83). 

The adverse effects reported with epidural administration are similar to those reported with the intrathecal route. Again, old age and respiratory disease probably dispose to respiratory depression (133). As can be predicted from pharmacokinetic considerations, delayed respiratory depression is more common with epidural morphine than with fentanyl (134). 

The intrathecal route is more invasive than i.v, i.m. or s.c routes. Both percutaneously implanted catheters and subcutaneously implantable pumps have heen used to reduce the risk of infection on repeated puncture. 

All vinca alkaloids are severe vesicants that can induce necrosis, cellulitis, and/or thrombophlebitis. Proper needle placement before administration should be assured to eliminate the risk of extravasation. Unlike the tissue damage caused by the vesicant action of nitrogen mustards and antibiotic antineoplastics, cold exacerbates tissue destruction. If extravasation occurs, apply heat for 1 hour fours time a day for 3 to 5 days, coupled with local hyaluronidase injections. Vinca alkaloids are all Category D teratogens and are fatal if administered by the intrathecal route. 

After carrying out a lumbar puncture and administering the correct cytotoxic therapy (Cytosine) under the supervision of the Specialist Registrar Dr Mitchell, Dr North, a Senior House Officer, was passed a second drug by Dr Mitchell to administer to Mr James, which he subsequently did. However, the second drug. Vincristine, should never be administered by the intrathecal route because it is almost always fatal. 

Grass JA. Fentanyl clinical use as postoperative analgesic-epidural/intrathecal route. / Pain Symptom Manage 1992 7 419-430. 

Baclofen, like other GABA agonists, can produce CNS depression. In addition, the intrathecal pump systems are complex and expensive. Like most implantantable devices they carry the risk of infection. Their subcutaneous position makes them vulnerable to damage with the potential for release of the entire baclofen dose. Inadvertent intrathecal overdose may also occur secondary to pump malfunction or dispensing errors. In approximately 5% of patients, the intrathecal route has no effect. 

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