Journal Article

THE INFLUENCE OF LOW SALIVARY FLOW RATES ON THE ABSORPTION OF A SUBLINGUAL FENTANYL CITRATE FORMULATION FOR BREAKTHROUGH CANCER PAIN

Vriens, J., Davies, A., Waghorn, M., Webber, K., Buchanan, A.

2022

Overview

There is no data on the pharmacokinetics of oral transmucosal opioids in patients with salivary gland hypofunction (SGH; 'dry mouth'), despite the fact that SGH may significantly amend absorption through the oral mucosa. Nine cancer patients with pain and SGH (unstimulated whole salivary flow rate<0.1 ml/min) completed a series of pharmacokinetic studies involving a sublingual fentanyl orally disintegrating tablet (Abstral[R]): on the first assessment, plasma fentanyl levels were measured after no intervention for the SGH; on the second assessment, plasma fentanyl levels were measured after moistening the mouth with water; on the third assessment, plasma fentanyl levels were measured after a 5 mg dose of pilocarpine (i.e. salivary stimulant). The Cmax, Tmax, and AUC were lowest during the first assessment phase (i.e. no intervention for SGH). The Cmax, Tmax, and AUC were similar during the second and third assessment phases. Figure 1 shows the plasma concentration–time profiles. The results of this study suggest that moistening the mouth is an effective intervention for improving the pharmacokinetic profile of the sublingual fentanyl orally disintegrating tablet (Abstral[R]) in patients with SGH. However, these results cannot be extrapolated to other oral transmucosal opioids.

• Publisher: Springer
• Subject: Fentanyl