Delivery of Neostigmine and Glycopyrrolate by Iontophoresis: A Nonrandomized Study in Individuals with Spinal Cord Injury

Spinal Cord, 2018 · DOI: 10.1038/s41393-017-0018-2 · Published: March 1, 2018

Spinal Cord Injury Pharmacology Gastroenterology

Simple Explanation

This study explores a new way to deliver medication for bowel issues in people with spinal cord injuries. It tests whether delivering neostigmine and glycopyrrolate through the skin using a technique called iontophoresis can help induce bowel movements compared to giving the medication intravenously. Iontophoresis uses a small electric current to help the drugs pass through the skin. The study looked at whether this method was safe and effective in helping people with spinal cord injuries have bowel movements. The researchers found that transdermal administration of neostigmine/glycopyrrolate by iontophoresis appears to be a practical, safe, and effective approach to induce bowel evacuation in individuals with spinal cord injury.

Study Duration

Two-year study

Participants

25 individuals with Spinal Cord Injury

Evidence Level

Phase I Clinical Trial

Key Findings

1
Transdermal administration of neostigmine/glycopyrrolate by iontophoresis appears to be a practical, safe, and effective approach to induce bowel evacuation in individuals with spinal cord injury.
2
Eighteen of 25 individuals (72.0%) had a bowel movement (20±22min) after intravenous neostigmine/glycopyrrolate.
3
Fewer side effects were observed in individuals who received neostigmine/glycopyrrolate transdermally compared to those who were administered intravenous neostigmine/glycopyrrolate.

Research Summary

The study compared transdermal administration of neostigmine/glycopyrrolate via iontophoresis to intravenous administration for bowel evacuation in spinal cord injury patients. Transdermal delivery resulted in fewer side effects compared to intravenous administration, suggesting a safer alternative. The study concludes that transdermal iontophoresis of neostigmine/glycopyrrolate is a practical, safe, and effective method for inducing bowel movements in individuals with SCI.

Practical Implications

Improved Bowel Management

Transdermal iontophoresis offers a less invasive and potentially safer method for bowel management in SCI patients compared to intravenous administration.

Reduced Side Effects

The transdermal approach reduces the incidence of cholinergic side effects, improving patient comfort and tolerability.

Home Use Potential

The non-invasive nature of iontophoresis makes it a suitable option for long-term bowel care in the home environment.

Study Limitations

1
The sample size was small, limiting the statistical power to detect significant differences between transdermal and intravenous routes.
2
Variability in skin permeability among individuals may affect the absorption and efficacy of transdermal drug delivery.
3
The study population was limited to individuals with chronic SCI, potentially limiting the generalizability to other populations.

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