Transmucosal drug administration as an alternative route in palliative and end-of-life care during the COVID-19 pandemic

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Transmucosal drug administration as an alternative route in palliative and end-of-life care during the COVID-19 pandemic

Lam, JKW; Cheung, CCK; Chow, MYT; Harrop, E; Lapwood, S; Barclay, SIG; Wong, I; (2020) Transmucosal drug administration as an alternative route in palliative and end-of-life care during the COVID-19 pandemic. Advanced Drug Delivery Reviews , 160 pp. 234-243. 10.1016/j.addr.2020.10.018. Green open access

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Abstract

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.

Type:	Article
Title:	Transmucosal drug administration as an alternative route in palliative and end-of-life care during the COVID-19 pandemic
Open access status:	An open access version is available from UCL Discovery
DOI:	10.1016/j.addr.2020.10.018
Publisher version:	https://doi.org/10.1016/j.addr.2020.10.018
Language:	English
Additional information:	This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords:	Benzodiazepine, Buccal, End-of-life drug, Intranasal, Opioid, Rectal, Sublingual, Systemic delivery
UCL classification:	UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Practice and Policy
URI:	https://discovery.ucl.ac.uk/id/eprint/10113596