New ITI Study Shows Potential Of Intranasal Midazolam As An Effective, Noninvasive Sedative
Main Category: Pain / AnestheticsAlso Included In: Anxiety / Stress
Article Date: 26 Jul 2006 - 0:00 PDT
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Intranasal Therapeutics, Inc. (ITI) announced today that a proof-of-principle study published in the August issue of the peer-reviewed journal Anesthesia & Analgesia demonstrates the potential of intranasally delivered midazolam as a convenient, fast-acting and noninvasive alternative to intravenous and oral forms of this widely used sedative.
"Our preliminary study in 12 healthy volunteers clearly demonstrates that this novel intranasal formulation of midazolam is rapidly and reliably absorbed," said Daniel P. Wermeling, Pharm.D., Associate Professor, College of Pharmacy at the University of Kentucky, and ITI's Chief Scientific Officer. "If further studies confirm our findings, the new formulation could be developed as a viable therapeutic alternative to injectable and oral dosage forms for relieving preprocedure anxiety in adults and children."
Approximately 100 million procedures are performed each year that require treatment for anxiety prior to surgery and other medical and dental procedures. Sedatives in the form of oral tablets, syrup and intramuscular options have clinical limitations, however, and no nasal alternative currently is available. ITI therefore is developing intranasal midazolam for sedation, amnesia and anxiety relief prior to or during medical procedures. An additional Phase I clinical study has been completed, and follow-up pharmacokinetic studies are in development.
The study entitled "Pharmacokinetics and Pharmacodynamics of a New Intranasal Midazolam Formulation in Healthy Volunteers" compared 5 mg of midazolam delivered to 12 healthy volunteers via intravenous, intramuscular and intranasal administration. Findings demonstrated that the intranasal dose was well absorbed very rapidly, i.e. in less than 10 minutes with 72 percent bioavailability. In addition, the intranasal dose demonstrated rapid onset and short duration of action, and its sedative effects were more similar to intravenous than to intramuscular administration.
The intranasal midazolam is also a sterile product, eliminating the use of potentially irritating antimicrobial preservatives; all subjects completed the study without clinically significant or serious adverse events.
Midazolam, like other benzodiazepines, is heat labile and cannot withstand terminal sterilization. ITI's unique aseptic nasal filling and manufacturing capability enables the production of benzodiazepines as well as protein and peptide nasal sprays. This capability was reported recently by In- PharmaTechnologist in an article entitled "Aseptic nasal spray manufacturing an untapped market." ITI continues its market leadership in aseptic, preservative-free nasal product development.
The midazolam study was conducted for ITI by investigators at the University of Kentucky's College of Pharmacy and Division of Otolaryngology
- Head & Neck Surgery, A. B. Chandler Medical Center. The abstract may be viewed at http://www.anesthesiaanalgesia.org/cgi/content/abstract/103/2/344.
Additional publications involving ITI's product candidates can be found at: http://www.intranasal.com/publications.html.
About ITI
Intranasal Therapeutics, Inc. (ITI) is a specialty pharmaceutical company focused on developing innovative nasally delivered pharmaceutical products, with a particular focus on drugs to treat pain and central nervous system disorders for which there is proven, unsatisfied consumer need. The Company currently has four products in its clinical development pipeline, with several others in formulation or preclinical development. ITI's goal is to become a leader in the field of intranasal pharmaceuticals by applying formulation expertise across a broad range of therapeutic areas to create new and differentiated products that improve safety, efficacy and convenience for patients, caregivers and health care professionals.
Intranasal Therapeutics, Inc.
http://www.intranasal.com
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Visitor Opinions In Chronological Order (57)
Midazolam Sedation Is Not ALWAYS Safe
posted by Jackie Murray on 16 Sep 2006 at 8:06 amMidazolam/Versed is not as safe as the manufacturer would like you to believe. It causes extreme mental reactions in some (maybe many) patients, which last well beyond the systemic life of the drug. Amnesia and /or a hypnotic effect is not always desired by the patient and should be explained clearly to the patient before application. This reaction is well known to the administrators of this drug, but it is not widely reported.
I Dislike Midazolam
posted by Tim on 16 Sep 2006 at 2:14 pmI agree with Jackie's posting. I was given Midazolam prior to a hernia repair with no explanation of the drug or its effects. I would have refused this drug under all circumstances if the anesthesiologist had been honest with me. I ended up having a bad reaction and was then given general anesthesia. It adds insult to injury because I have experienced many operations while wide awake with no problems. I am very pain tolerant and not at all squeamish about surgery. My wife was present during the pre-op consultation and we both agree in retrospect that the anesthesiologist was deliberately sneaky and essentially, by committing lies of omission, forced this awful drug on me.
I object to the amnesia and I object to how this drug is used. After starting Versed Busters (http://versedbusters.blogspot.com/) and sharing experiences with a large number of people, it is clear that there is a widespread pattern of abuse.
If it were up to me, I'd ban this drug entirely.
Midazolam Aka Versed Is Evil
posted by Lois on 11 Jan 2007 at 9:42 pmI also had a bad experience with Versed. It was administered to me first during a colonoscopy. I didn't know what it was. I was told that I would be getting a twilight sedation. For weeks, actually months afterwards I had a weird feeling of trying to recall something.
I found out what I had been administered and did an internet search. When I found out that Versed causes amnesia it made sense to me why I was feeling so weird from it. Then I had surgery and assumed that I would be receiving general anesthesia only.
I was very upset to find out that Versed was being given to me just prior to entering the OR. I wrote a letter to the hospital to inform them that they should advise patients first before assuming that they would want this drug. The hospital administration advised me to always state from now on if I have surgery to write down that I am allergic to Versed. I think that was a cop out on their part.
I think that everyone had a right to be informed that they are going to be given an unnecessary drug.
Versed Busters Page
posted by Tim on 22 Jan 2007 at 12:03 pmLois:
I would like to have your comments posted to my site as well:
http://versedbusters.blogspot.com/
Feeling Violated
posted by april cleveland on 10 Feb 2007 at 6:10 pmI didn"t go to a doctor for ten years after less than ideal experiences. Have been going to mine for 5 years now & thought I could trust him. I feel like he help a sadist to torture me for a half hour for colonoscopy even though I can't remember . I am 58 year old woman. If I have anything wrong I'll die from it before I go back.
Bad Reaction To Versed
posted by kent on 1 Apr 2007 at 8:00 pmI had Versed two days ago for a dental procedure. It was the most terrifying experience I've ever had. It felt like I was being forced up a vacume where all sides of me were many mirrors and glass, and I had no control over this as I felt like I was racing in the air trying to reach the end of the "glass" but it never ended.
I know this sounds crazy, but I'm still recovering today, and I get terrified when I even think about it. (I'm 56 and an R.N.).
Thought that I was dying. I was trying to scream but no one could hear. I did notice the shadowy shapes of the dentist and his assistant as they hovered above me, but I believe I came very close to having a heart attack.!!
Respiratory Failure And Convulsions
posted by Alex on 20 May 2008 at 12:49 pmI had to have back surgery a couple of years ago and was administered Versed (Midazolam). Typically when a patient starts to spasm, they are either allergic or do not have enough Midazolam in the system. So a second dose was administered in which I began to convulse and went into respiratory failure according to my surgeon. They had to inject flumazenil (Anexate) an antidote to reverse the effects.
We are the unlucky 0.1% of the world population who is allergic to this most abundantly used sedative. I recommend to any of you to get a necklace or bracelet from http://www.americanmedical-id.com, just in case you are not able to communicate your allergies.
Beware Versed
posted by Sharon on 10 Sep 2008 at 8:28 amI was given Versed for cataract surgery. I was told it was a benzo sedative and was not told about amnesia qualities. As soon as it was administered I went into a panic. I was completely aware during the surgery, but unable to communicate. I clenched my fists, but no one seemed to get that I was in a complete state of panic. Just as well, they probably would have given me more. When I was picked up I was freaked out and just kept saying "get me out of here." I remember nothing else for two days except wandering around the house, uncoordinated, and bumping into walls. I still have a lingering feeling of panic and lack of control. I have to have a second surgery and they are telling me they will adjust the dosage. I may cancel the surgery if I can't convince them that they will never give me any amount of this drug. I don't feel the professionals understand how it can mess up patients. Maybe they like it because it keeps them quiet and "under control."
Versed Was Ok For Me.
posted by Johnny Hotsot on 29 Sep 2008 at 10:48 pmA few days ago I dislocated my shoulder and was brought by ambulance to the local hospital. I was given morphine for the pain when I got to the ER. Before they popped my arm back in, they gave me more morphine and said they were going to give me something else to sedate me. I asked what it was and they said Versed. I've been an EMT for almost ten years now, so that's what prompted me to ask. They told me I might have no recollection of the events, and I was OK with that. They also hooked me up to a cardiac monitor to be on the safe side in case I crashed.
I remember them pushing the drugs, then I woke up back on the x-ray table. My girlfriend, who was with me through all the procedures said I was conscious through everything.
I can definitely see how people have problems with drugs like this not knowing the effects. It's one thing if you know there is a possibility of complete blackout and amnesia, but if they fail to warn you, I can see how the amnesia would bother some. Not something to be taken lightly.
I Love Versed
posted by Tom K on 5 Feb 2009 at 3:38 pmI've had multiple procedures with versed. One was a neck biopsy (where local anesthetic would not have been an option) and also for a combination colonoscopy and upper gi endoscopy.
I had no memory of any of the procedures, which was fine with me. The last thing I remembered was being hooked up to an IV. I was told what I was getting, that it would calm me, and that I would have no memory of the procedures.
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