TY  - JOUR
AV  - public
KW  - Benzodiazepine
KW  -  Buccal
KW  -  End-of-life drug
KW  -  Intranasal
KW  -  Opioid
KW  -  Rectal
KW  -  Sublingual
KW  -  Systemic delivery
ID  - discovery10113596
N2  - The Coronavirus disease 2019 (COVID-19) pandemic has led to a surge in need for alternative routes of administration of drugs for end of life and palliative care, particularly in community settings. Transmucosal routes include intranasal, buccal, sublingual and rectal. They are non-invasive routes for systemic drug delivery with the possibility of self-administration, or administration by family caregivers. In addition, their ability to offer rapid onset of action with reduced first-pass metabolism make them suitable for use in palliative and end-of-life care to provide fast relief of symptoms. This is particularly important in COVID-19, as patients can deteriorate rapidly. Despite the advantages, these routes of administration face challenges including a relatively small surface area for effective drug absorption, small volume of fluid for drug dissolution and the presence of a mucus barrier, thereby limiting the number of drugs that are suitable to be delivered through the transmucosal route. In this review, the merits, challenges and limitations of each of these transmucosal routes are discussed. The goals are to provide insights into using transmucosal drug delivery to bring about the best possible symptom management for patients at the end of life, and to inspire scientists to develop new delivery systems to provide effective symptom management for this group of patients.
SP  - 234
N1  - This version is the author accepted manuscript. For information on re-use, please refer to the publisher?s terms and conditions.
UR  - https://doi.org/10.1016/j.addr.2020.10.018
EP  - 243
A1  - Lam, JKW
A1  - Cheung, CCK
A1  - Chow, MYT
A1  - Harrop, E
A1  - Lapwood, S
A1  - Barclay, SIG
A1  - Wong, I
Y1  - 2020///
TI  - Transmucosal drug administration as an alternative route in palliative and end-of-life care during the COVID-19 pandemic
JF  - Advanced Drug Delivery Reviews
PB  - Elsevier
VL  - 160
ER  -