Pharmacokinetics of adrenaline autoinjectors.
Author(s)
Turner, Paul J
Muraro, Antonella
Roberts, Graham
Type
Journal Article
Abstract
Anaphylaxis is a medical emergency with adrenaline acknowledged as the first line therapy. It is therefore important that patients have access to self-injectable adrenaline in the community. Manufacturers have been requested by European Medicine Regulators to generate pharmacokinetic data for these autoinjector devices. For the first time, these data provide an insight into how individual devices work in different populations, and how they compare. We undertook a thorough literature search and also accessed grey literature, using searches of medicine regulators' websites and freedom of information requests. The data demonstrate that it takes at least 5-10 minutes to achieve early peak plasma concentration for most devices. The specific autoinjector device seems to be the most important determinant of pharmacokinetics, with different devices giving rise to different plasma adrenaline profiles. Needle length does not seem to be the most important factor; rather, the force and speed of injection (which varies from one device to another) is likely to be of greater importance. In general, peak plasma adrenaline concentration is lower and time-to-peak concentration longer with increased skin-to-muscle depth. However, it is difficult to draw conclusions with the current available data, due to a lack of head-to-head comparisons, small numbers of study participants, and the failure to acknowledge the biphasic nature of intramuscular adrenaline absorption for analysis purposes.
Date Issued
2021-11-16
Date Acceptance
2021-11-13
Citation
Clinical and Experimental Allergy, 2021, 52 (1), pp.18-28
ISSN
0954-7894
Publisher
Wiley
Start Page
18
End Page
28
Journal / Book Title
Clinical and Experimental Allergy
Volume
52
Issue
1
Copyright Statement
© 2021 The Authors. Clinical & Experimental Allergy published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Sponsor
Medical Research Council (MRC)
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/34784074
Grant Number
MR/K010468/1
Subjects
anaphylaxis
autoinjectors
pharmacokinetics
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2021-11-16