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Buccal acetaminophen provides fast analgesia: two randomized clinical trials in healthy volunteers

Authors Pickering G, Macian N, Libert F, Cardot JM, Coissard S, Perovitch P, Maury M, Dubray C

Received 4 March 2014

Accepted for publication 9 April 2014

Published 26 September 2014 Volume 2014:8 Pages 1621—1627

DOI https://doi.org/10.2147/DDDT.S63476

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Gisèle Pickering,1–3 Nicolas Macian,1 Frédéric Libert,2,4 J Michel Cardot,1 Séverine Coissard,1 Philippe Perovitch,5 Marc Maury,5 Claude Dubray1–3

1CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France; 2Inserm, Clermont-Ferrand, France; 3Clermont Université, Laboratoire de Pharmacologie, Faculté de Médecine, Clermont-Ferrand, France; 4Laboratoire de Pharmacologie, CHU Clermont-Ferrand, France; 5Unither Pharamceuticals, Paris, France

Background: Acetaminophen (APAP) by oral or intravenous (iv) routes is used for mild to moderate pain but may take time to be effective. When fast relief is required and/or oral or iv routes are not available because of the patient's condition, the transmucosal route may be an alternative.
Methodology: A new transmucosal/buccal (b) pharmaceutical form of APAP dissolved in 50% wt alcohol is compared with other routes of administration. Two consecutive randomized, crossover, double-blind clinical trials (CT1: NCT00982215 and CT2: NCT01206985) included 16 healthy volunteers. CT1 compared the pharmacology of 250 mg bAPAP with 1 g iv APAP. CT2 compared the pharmacodynamics of 125 mg bAPAP with 1 g iv and 125 mg sublingual (s) APAP. Mechanical pain thresholds are recorded in response to mechanical stimuli applied on the forearm several times during 120 minutes. The objective is to compare the time of onset of antinociception and the antinociception (area under the curve) between the routes of administration with analysis of variance (significance P<0.05).
Results: bAPAP has a faster time of antinociception onset (15 minutes, P<0.01) and greater antinociception at 50 minutes (P<0.01, CT1) and 30 minutes (P<0.01, CT2) than ivAPAP and sAPAP. All routes are similar after 50 minutes.
Conclusion: bAPAP has a faster antinociceptive action in healthy volunteers. This attractive alternative to other routes would be useful in situations where oral or iv routes are not available. This finding must now be confirmed in patients suffering from acute pain of mild and moderate intensity.

Keywords: transmucosal delivery, pain, healthy volunteer

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