OBJECTIVE: Treatment of mood and behavioral symptoms in geriatric patients with advanced dementia may be impeded by poor compliance with oral medications. Pluronic lecithin organogel (PLO) is a compounding substrate that can be used for the topical administration of psychotropic medications.
METHODS: Charts of patients treated with psychotropic medications compounded with PLO cream were reviewed for treatment outcomes. All patients were treated by a nursing home outreach service.
RESULTS: Records from twenty-four patients, mean age 86.8 + 5.9, were reviewed. Common psychiatric symptoms included agitation, aggressive behavior, and depression. Medications most commonly administered as a PLO cream included quetiapine and venlafaxine. All patients had mild to marked improvement in psychiatric symptoms.
CONCLUSIONS: Pluronic lecithin organogel (PLO) may be an effective option for the topical administration of psychiatric medications in geriatric patients with dementia who are not compliant with oral medications.
1. Selbaek G, Kirkevold O, Encreamal K. The course of psychiatric and behavioral symptoms and the use of psychotropic medication in patients with dementia in Norwegian nursing homes, a 12 month follow-up study. Am J Geriatr Psychiatry. 2008;16:528-36. https://doi.org/10.1097/jgp.0b013e318167ae76
2. Shin IS, Carter M, Masterman D, Fairbanks L, Cummings JL. Neuropsychiatric symptoms and quality of life in Alzheimer disease. Am J Geriatr Psychiatry. 2005;13:469-74. https://doi.org/10.1097/00019442-200506000-00005
3. Vintiloiu A, Leroux JC. Organocreams and their use in drug delivery, a review. J Control Release. 2008;125:179-92.
4. Avramiotis S, Papadimitriou V, Hatzara E, Bakiari V, Lianos P, Xenakis A. Lecithin organocreams used as bioactive compounds carriers. A microdomain properties investigation. Langmuir. 2007;23:4438-4447. https://doi.org/10.1021/la0634995
5. Kumar R, Katar e OP. Lecithin organocreams as a potential phospholipids-structured system for topical drug delivery: a review. AAPS Pharm Sci Tech. 2005;6:E298-310. https://doi.org/10.1208/pt060240
6. Silberstein PT, Bhaskara A. Transdermal creams: a novel delivery system for rescue of delayed nausea and vomiting. J Clin Oncology. 2005;23:8201.
7. Bleicher J, Bhaskara A, Huyck T, Constantino S, Bardia A, Loprinzi CL, et al. Lorazepam, diphenhydramine, and haloperidol transdermal cream for rescue from chemotherapy-induced nausea/vomiting: results of two pilot trials. J Support Oncol. 2008;6:27-32.
8. Smith TJ, Ritter JK, Poklis JL, Fletcher D, Coyne PJ, Dodson P, et al. ABH gel is not absorbed from the skin of normal volunteers. J Pain Symptom Manage. 2012;43(5):961-966. https://doi.org/10.1016/j.jpainsymman.2011.05.017
9. Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. J Psychiar Res. 1975;12:189-198.
10. Weiland AM, Protus BM, Kimbrel J, Grauer PA, Hirsh J. Chlorpromazine bioavailability from a topical gel formulation in volunteers. J Support Oncol. 2013;11(3):144-8. https://doi.org/10.12788/j.suponc.0010
11. Paice JA, Von Roenn JH, Hudgins JC, Luong L, Krejcie TC, Avram MJ. Morphine bioavailability from a topical gel formulation in volunteers. J Pain Symptom Manage. 2008;35:314-320. https://doi.org/10.1016/j.jpainsymman.2007.04.016
12. Glisson JK, Wood RL, Kyle PB, Cleary JD. Bioavailability of promethazine in a topical pluronic lecithin organogel: a pilot study. Int J of Pharm Compounding. 2005;9:242-246.
13. Sylvester RK, Schauer C, Thomas J, Steen P, Weisenberger A. Evaluation of methadone absorption after topical administration to hospice patients. J Pain Symptom Manage. 2011;41(5):828-35. https://doi.org/10.1016/j.jpainsymman.2010.07.018
14. Kaestli LZ, Wasilewski-Rasca AF, Bonnabry P, Vogt-Ferrier N. Use of transdermal drug formulations in the elderly. Drugs Aging. 2008;25(4):269-80. https://doi.org/10.2165/00002512-200825040-00001
Available at: http://works.bepress.com/suzanne_holroyd/1/