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© The Board of Management and Trustees of the British Journal of Anaesthesia [2007]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Transdermal drug delivery: principles and opioid therapy
1 Specialist Registrar in Anaesthesia
Derriford Hospital
Plymouth
UK
2 Consultant in Anaesthesia and
Pain Management
Eric Angel Pain Clinic
Level 7
Derriford Hospital
Plymouth PL6 8DH
UK
Tel: +44 1752 792525 Fax: +44 1752 517556 E-mail: richard.sawyer@phnt.swest.nhs.uk
Key Words: The transdermal route for drug delivery avoids first pass metabolism and large variations in plasma drug concentrations. • The stratum corneum is the greatest barrier to transdermal transport. • Drugs suitable for transdermal administration have a low molecular weight and high lipid solubility. • There are two types of patches available: reservoir and matrix systems. • Opioid patches are frequently utilized in chronic malignant and non-malignant pain management.
| The first 150 words of the full text of this article appear below. |
The application of medications to the skin to ease ailments is a practice that has been utilized by humankind over the millennia and has included the application of poultices, gels, ointments, creams, and pastes. These applications were primarily intended for a local topical effect. The use of adhesive skin patches to deliver drugs systemically is a relatively new phenomenon.1
The first adhesive transdermal delivery system (TDDS) patch was approved by the Food and Drug Administration in 1979 (scopolamine patch for motion sickness). Nitroglycerine patches were approved in 1981. This method of delivery became widely recognized when nicotine patches for smoking cessation were introduced in 1991.
TDDS offer pharmacological advantages over the oral route and improved patient acceptability and compliance. As such, they have been an important area of pharmaceutical research and development over the last few decades. Conditions for which TDDS are suitable are detailed in Table 1.
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Skin structure |
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Pharmacokinetics of transdermal drug delivery |
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Effect of drug characteristics
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Transdermal delivery systems |
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Improving transdermal drug delivery
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Opioid transdermal drug delivery systems |
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Fentanyl TDDS (reservoir and matrix)
Fentanyl patient-controlled transdermal system
Buprenorphine TDDS (matrix)
Clinical efficacy of opioid TDDS
Perioperative pain management of patients using opioid patches