farmaci topici marco paoloni xx congresso nazionale sicd - rome rehabilitation 2011 sindromi algiche...
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Farmaci topici
Marco PaoloniMarco Paoloni
XX CONGRESSO NAZIONALE SICD - ROME REHABILITATION 2011Sindromi algiche del distretto lombo-sacrale e dell’arto inferiore
Site of inflammation: Site of inflammation:
Not always inflamed sites can be easily reached by drugs through systemic circulation
Passaggio di sostanze dalla superficie esterna della cute agli strati sottostanti
TERAPIA TRANSDERMICATERAPIA TRANSDERMICA
Preparati per uso topicoPreparati per uso topico
PRINCIPIO ATTIVO VEICOLO
ATTIVITA’ FARMACOLOGICA (PROMOTORI DI
ASSORBIMENTO)
ECCIPIENTI
Preparati per uso topicoPreparati per uso topico
UNGUENTIUNGUENTI
PASTEPASTE
POMATE/CREMEPOMATE/CREME
SCHIUME MEDICATESCHIUME MEDICATE
GELGEL
CEROTTI MEDICATICEROTTI MEDICATI
La via transdermicaLa via transdermica
Elettiva localizzazione nel sito di infiammazioneElettiva localizzazione nel sito di infiammazione
Assenza degli effetti collateralisistemici tipici dei FANS per via oraleAssenza degli effetti collateralisistemici tipici dei FANS per via orale
Azione più rapida sul sito di infiammazioneAzione più rapida sul sito di infiammazione
Il successo della via transdermicaIl successo della via transdermica
CARATTERISTICHE DEL PRINCIPIO ATTIVO
Dosaggio Peso Molecolare dei
FANS % assorbimento del principio attivo Grado di Lipofilia Sede infiammata da
raggiungere
Tecnologiadel sistema transdermico
Caratteristiche di ketoprofeneCaratteristiche di ketoprofene
Indometacina
PM 350 dalton
Piroxicam
PM 330 dalton
Diclofenac
PM 325 dalton
Ketoprofene
PM 260 dalton
Flurbiprofene
PM 250 dalton
KETOPROFENE ha un basso Peso Molecolare KETOPROFENE ha un basso Peso Molecolare
0
100
100
- +-
+
Efficacy
Perc
uta
neou
s a
bsorb
an
ce
wit
hin
4 h
ou
rs (
%)
KP
DC
FP
IM
KP = ketoprofeneFP = flurbiprofeneDC = diclofenacIM = indometacine
Absorbance/Efficacy of ketoprofene is higher
than other NSAIDs
Particularly suitable for transdermic application
(Yano et al.)
% of absorbance of the active principle% of absorbance of the active principle
Relazione tra lipofilia e assorbimento cutaneoRelazione tra lipofilia e assorbimento cutaneo
1 2 3 4 5
2
1
Logari
tmo d
ella
% d
i ass
orb
imento
AU
MEN
TO
AS
SO
RB
IMEN
TO
Logaritmo del coefficiente di ripartizione(n-ottanolo/acqua)
AUMENTO LIPOFILIA
Diclofenac
Indometacina
Ketoprofene
Flurbiprofene
KETOPROFENE ha un valore di log p= 2,94 prossimo al valore ottimale ed è quindi uno dei FANS con la più alta permeabilità percutanea
KETOPROFENE ha un valore di log p= 2,94 prossimo al valore ottimale ed è quindi uno dei FANS con la più alta permeabilità percutanea (Tadanori et al.)
Valore ottimale
TECNOLOGY OF THE TECNOLOGY OF THE
TRANSDERMIC SYSTEMTRANSDERMIC SYSTEM
MOLECULE TRANSDERMIC SYSTEM
Diclofenac Natural rubber based
Flurbiprofene Natural rubber based
Ketoprofen Non aqueous matrix (SIS system = Styrene -Isoprene- Styrene)
Non aqueous matrix topical plaster application - SIS
ketoprofen 20 mg Topical plaster applicationketoprofen 20 mg Topical plaster application
KetoprofenKetoprofen
BaseBase
Sustained release of the active Sustained release of the active principleprinciple
technology
ketoprofen 20 mg Topic plaster application- ketoprofen 20 mg Topic plaster application- Exclusive matrix polimeric SISExclusive matrix polimeric SIS
3 component copolymer:- Styrene-Isoprene- Styrene
Includes and structures the ketoprofen in a stable
and regular way
Even and steady release of the active principle
continuously
Ideal structural propertiesIdeal structural properties
The SIS matrix guides the Ketoprofen release
Improving its percutaneous permeability
Ketoprofen
ONCE A DAY APPLICATION Sustained release within 24 hours
Kuzumaki N et al
ketoprofen 20 mg topical plaster application– ketoprofen 20 mg topical plaster application– Exclusive polymeric matrix SISExclusive polymeric matrix SIS
ketoprofen 20 mg Topical plaster application:ketoprofen 20 mg Topical plaster application:Absorption and action speedAbsorption and action speed
Quanti
ty o
f p
rod
uct
ab
sorb
ed
by s
kin
aft
er
a s
ing
le a
pp
licati
on (g
/cm
2)
Hours
Takada Y et al
Quantity of active principle detected in the skin after a single topic application of Quantity of active principle detected in the skin after a single topic application of Ketoprofen, Flubiprofene o DiclofenacKetoprofen, Flubiprofene o Diclofenac
High elasticity Perfect adhesion
Suitable also in flexible areas
ketoprofene 20 mg topic plaster: Advantagesketoprofene 20 mg topic plaster: Advantages
Optimal Adhesion and flexibilityOptimal Adhesion and flexibility
Intra-articular absorption and distribution of Ketoprofen after topical plaster application and oral intake in 100 patient undergoing knee arthroscopy Reumatology 1999; 38: 564-567 Rolf C. et al
Objective: Assessment of the kinetic of ketoprofen in synovial fluid and intra-articular tissue in relation to plasma.
Methods: Ketoprofen concentration was analyzed in plasma, synovial fluid and intra-articular tissues after single application of 30 mg plaster or oral intake of 50 mg in patients undergoing knee arthroscopy.
Results : median Cmax values after topical application were 12.8 ng/ml in synovial fluid, 56.7 ng/g in synovial tissue, 349.3 ng/g in meniscus and 568.9 ng/g in cartilage.
Conclusion: topical application of ketoprofen allow the attainment of high intra-articluar tissue concentration.
Tissue Median Cmax T
Median Cmax O
Synovial tissue
Meniscus
Cartilage
Plasma
Synovial fluid
56,7
349,3
568,9
18,7
12,8
363,9
85,7
83,5
2595,3
353,8
Reumatology 1999; 38: 564-567 Rolf C. et al
Intra-articular absorption and distribution of Ketoprofen after topical plaster application and oral intake in 100 patient undergoing knee arthroscopy
Symptomatic treatment of Pain and inflammation caused by Acute Osteo muscular diseases
such as trauma, strains and bruisings
ketoprofen 20 mg Topic plaster application:ketoprofen 20 mg Topic plaster application:Indication :Indication :
Ketoprofen 20mg topic plaster application:
anti-inflammatory and antalgic affect
Ketoprofen 20mg topic plaster application:
anti-inflammatory and antalgic affect
Percent of patients showing an improving of the back pain, patients without benefits and declined despite the previous condition after 2 weeks therapy, with oral ketoprofen 50 mg t.i.d. (n. 62) or topic transdermic ketoprofen plaster(n.59).
Comparison with oral ketoprofen in the low back pain
Sugioka Y et al
Double blind trial involving 184 patients comparing Ketoprofen topic plaster (1 plaster/day ) and oral ketoprofen 50 mg 3 times/day, for 2 weeks.
General improving of signs and symptoms of low back pain
% o
f p
atie
nts
Takagishi N et al
Ketoprofen 20mg topic plaster application:
anti-inflammatory and antalgic effect
Ketoprofen 20mg topic plaster application:
anti-inflammatory and antalgic effect
Trial utilizing ketoprofen plaster, 1plaster/day for 2 weeks involving 174
patients suffering different post-traumatic diseases
Improving of 63% in Scapulo Humeralis Periartritis
70% of patients improve in the other diseases
Aoki T e et al
Ketoprofen 20mg topic plaster application:
anti-inflammatory and antalgic affect
Ketoprofen 20mg topic plaster application:
anti-inflammatory and antalgic affect
Dalla Letteratura…
Massey T, Derry S, Moore RA, McQuay HJ. Topical NSAIDs for acute pain in adults. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD007402. DOI: 10.1002/14651858.CD007402.pub2
CONCLUSIONICONCLUSIONI
La terapia con FANS topici si dimostra efficace e sicura nel
trattamento delle condizioni muscoloscheletriche acute
La scelta dell’uso del trattamento per via topica è dettata da
fattori legati al tipo di lesione ed al tipo di molecola