Nose-to-Heart Approach: Unveiling an Alternative Route of Acute Treatment.
Paraskevi PapakyriakopoulouGeorgia ValsamiNikolaos P E KadoglouPublished in: Biomedicines (2024)
Intranasal (IN) administration has emerged as a novel approach for rapid systemic absorption, with potential applicability in the management of acute cardiovascular events. This review explores the evolution of IN cardiovascular pharmacotherapy, emphasizing its potential in achieving systemic effects and bypassing the first-pass metabolism associated with oral administration. The extensive vascularization of nasal mucosa and a porous endothelial basement membrane facilitate efficient drug absorption into the bloodstream. The IN route ensures a critical swift onset of action, which allows self-administration in at-home settings. For instance, etripamil nasal spray, a first-in-class formulation, exemplifies the therapeutic potential of this approach in the treatment of spontaneous supraventricular tachycardia. The review critically assesses studies on IN formulations for angina, acute myocardial infarction, hypertensive episodes, and cardiac arrhythmias. Preclinical evaluations of beta-blockers, calcium-channel blockers, and antianginal drugs demonstrate the feasibility of IN administration for acute cardiovascular events. A small number of clinical trials have revealed promising results, emphasizing the superiority of IN drug delivery over oral administration in terms of bioavailability and onset of action. Unambiguously, the limited clinical trials and patient enrollment pose challenges in generalizing experimental outcomes. However, the nose-to-heart approach has clinical potential.
Keyphrases
- cardiovascular events
- coronary artery disease
- clinical trial
- liver failure
- drug induced
- drug delivery
- acute myocardial infarction
- cardiovascular disease
- respiratory failure
- percutaneous coronary intervention
- left ventricular
- aortic dissection
- heart failure
- blood pressure
- endothelial cells
- atrial fibrillation
- intensive care unit
- stem cells
- randomized controlled trial
- metabolic syndrome
- hepatitis b virus
- healthcare
- coronary artery
- emergency department
- case report
- bone marrow
- single cell
- acute coronary syndrome
- health insurance
- chronic rhinosinusitis
- climate change
- cell therapy
- risk assessment
- mechanical ventilation
- insulin resistance
- catheter ablation
- multidrug resistant
- tissue engineering
- phase iii