Department of Pharmacy and Pharmaceutical Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Valencia, Spain.
Department of Medical Affairs, Sandoz SA PE Parque Norte, Edificio Roble, C/Serrano Galvache, Madrid, Spain.
Adv Ther. 2019 Nov;36(11):2986-2996. doi: 10.1007/s12325-019-01101-6. Epub 2019 Oct 5.
The subcutaneous administration route is widely used to administer different types of drugs given its high bioavailability and rapid onset of action. However, the sensation of pain at the injection site might reduce patient adherence. Apart from a direct effect of the drug itself, several factors can influence the sensation of pain: needle features, injection site, volume injected, injection speed, osmolality, viscosity and pH of formulation, as well as the kind of excipients employed, including buffers and preservatives. Short and thin needles, conveniently lubricated and with sharp tips, are generally used to minimize pain, although the anatomic injection site (abdomen versus thigh) also affects the sensation of pain. Large subcutaneous injection volumes are associated with pain. In this sense, the maximum volume generally accepted is around 1.5 ml, although volumes of up to 3 ml are well tolerated when injected in the abdomen. Injected volumes of up to 0.5-0.8 ml are not expected to increase substantially the pain produced by the needle insertion. Ideally, injectable products should be formulated as isotonic solutions (osmolality of about 300 mOsm/kg) and no more than 600 mOs/kg have to be used in order to prevent pain. A pH close to the physiological one is recommended to minimize pain, irritation, and tissue damage. Buffers are frequently added to parenteral formulations to optimize solubility and stability by adjusting the pH; however, their strength should be kept as low as possible to avoid pain upon injection. The data available recommend the concentration of phosphate buffer be limited to 10 mM and that the concentration of citrate buffer should be lower than 7.3 mM to avoid an increased sensation of pain. In the case of preservatives, which are required in multiple-dose preparations, m-cresol seems to be more painful than benzyl alcohol and phenol.Funding: Sandoz SA.
皮下给药途径因其生物利用度高和作用起效快而被广泛用于施用各种类型的药物。然而,注射部位的疼痛感可能会降低患者的依从性。除了药物本身的直接作用外,还有几个因素会影响疼痛感觉:针的特征、注射部位、注射量、注射速度、制剂的渗透压、粘度和 pH 值,以及所使用的赋形剂的种类,包括缓冲剂和防腐剂。短而细的针,方便润滑且针尖锋利,通常用于最大程度地减轻疼痛,尽管解剖学上的注射部位(腹部与大腿)也会影响疼痛感觉。大的皮下注射量与疼痛有关。在这方面,一般接受的最大容量约为 1.5 毫升,尽管当在腹部注射时,可耐受高达 3 毫升的容量。注射量高达 0.5-0.8 毫升预计不会显著增加针插入引起的疼痛。理想情况下,可将可注射产品配制成等渗溶液(渗透压约为 300 mOsm/kg),并且为了防止疼痛,使用的渗透压不得超过 600 mOsm/kg。建议使用接近生理 pH 值的 pH 值来最大程度地减少疼痛、刺激和组织损伤。为了优化溶解度和稳定性,通常会向注射用制剂中添加缓冲剂以调节 pH 值;然而,应尽可能将其强度保持在较低水平,以避免注射时疼痛。现有数据建议将磷酸盐缓冲液的浓度限制在 10 mM 以内,并且柠檬酸缓冲液的浓度应低于 7.3 mM,以避免疼痛感觉增加。对于多剂量制剂所需的防腐剂,间甲酚似乎比苯甲醇和苯酚更痛。资金来源:山德士公司。
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