Sublingual epinephrine tablets versus intramuscular injection of epinephrine: Dose equivalence for potential treatment of anaphylaxis Mutasem M. Rawas-Qalaji,

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Presentation transcript:

Sublingual epinephrine tablets versus intramuscular injection of epinephrine: Dose equivalence for potential treatment of anaphylaxis Mutasem M. Rawas-Qalaji, BPharm, F. Estelle R. Simons, MD, Keith J. Simons, PhD Journal of Allergy and Clinical Immunology Volume 117, Issue 2, Pages 398-403 (February 2006) DOI: 10.1016/j.jaci.2005.12.1310 Copyright © 2006 American Academy of Allergy, Asthma and Immunology Terms and Conditions

Fig 1 Transcellular absorption of epinephrine from the sublingual cavity into the sublingual venous circulation. C1 epinephrine concentration, which depends on the epinephrine dose and the volume of saliva available; C2 epinephrine concentration within the mucosal epithelial cells; C3 epinephrine concentration in the interstitial fluid; C4 plasma epinephrine concentration. From Bundle: Human Physiology: From Cells to Systems (with CD-ROM and InfoTrac), 5th + Photo Atlas for Biology 5th edition by Sherwood.18 © 2004. Adapted and reprinted with permission of Brooks/Cole, a division of Thomson Learning: www.thomsonrights.com. Journal of Allergy and Clinical Immunology 2006 117, 398-403DOI: (10.1016/j.jaci.2005.12.1310) Copyright © 2006 American Academy of Allergy, Asthma and Immunology Terms and Conditions

Fig 2 Plasma epinephrine concentration versus time plots after administration of epinephrine or placebo sublingually (SL) and after epinephrine intramuscular injection (IM). Mean (±SEM) AUC, Cmax, and Tmax after administration of 40 mg epinephrine sublingual tablets and epinephrine intramuscular injections were not significantly different (P > .05). Journal of Allergy and Clinical Immunology 2006 117, 398-403DOI: (10.1016/j.jaci.2005.12.1310) Copyright © 2006 American Academy of Allergy, Asthma and Immunology Terms and Conditions

Fig 3 Plasma epinephrine concentration versus time plots after administration of epinephrine or placebo sublingually (SL) and after epinephrine intramuscular injection (IM). Mean (±SEM) AUC, Cmax, and Tmax after administration of 40 mg epinephrine sublingual tablets and epinephrine intramuscular injections were not significantly different (P > .05). Journal of Allergy and Clinical Immunology 2006 117, 398-403DOI: (10.1016/j.jaci.2005.12.1310) Copyright © 2006 American Academy of Allergy, Asthma and Immunology Terms and Conditions

Fig 4 Correlation between epinephrine sublingual dose and the bioavailability of epinephrine. The linear increase in the epinephrine dose administered resulted in a linear increase (R2 = 0.95) in epinephrine bioavailability (AUC). Each data point is expressed as the mean ± SEM of individual AUC values. Journal of Allergy and Clinical Immunology 2006 117, 398-403DOI: (10.1016/j.jaci.2005.12.1310) Copyright © 2006 American Academy of Allergy, Asthma and Immunology Terms and Conditions