Bioavailability and Pharmacokinetics of Lorazepam after Intranasal, Intravenous, and Intramuscular Administration

The purpose of this study was to evaluate the pharmacokinetic profile of intranasal lorazepam in comparison to currently established administration routes. Eleven healthy volunteers completed this randomized crossover study. On three occasions, each separated by a 1‐week washout, subjects received a 2 mg dose of lorazepam via the intranasal, intravenous, or intramuscular route. Blood samples were collected serially from 0 to 36 hours. Noncompartmental methods were used to determine pharmacokinetic parameters. Lorazepam was well absorbed following intranasal administration with a mean (%CV) bioavailability of 77.7 (11.1). Intranasal administration resulted in a faster absorption rate than intramuscular administration. Elimination profiles were comparable between all three routes. The concentration‐time profile for intranasal delivery demonstrated evidence of a double peak in several subjects, suggesting partial oral absorption. Females were found to have significantly higher AUC values than males for all three delivery routes. Overall, this study demonstrated favorable pharmacokinetics of intranasal lorazepam in relation to standard administration methods. Intranasal delivery could provide an alternative, noninvasive delivery route for lorazepam.

[1]  R. Kriel,et al.  Bioavailability of rectally administered lorazepam. , 1987, Clinical neuropharmacology.

[2]  F. Kristjánsson,et al.  Disposition of alprazolam in human volunteers. Differences between genders. , 1991, Acta pharmaceutica Nordica.

[3]  S. Schenker,et al.  Effects of aging and liver disease on disposition of lorazepam , 1978, Clinical pharmacology and therapeutics.

[4]  D. Greenblatt,et al.  Clinical pharmacokinetics of lorazepam: a review. , 1978, The Journal of clinical psychiatry.

[5]  P. Gervasi,et al.  Biotransformation enzymes in nasal mucosa and liver of Sprague-Dawley rats. , 1988, Toxicology letters.

[6]  E. Bechgaard,et al.  Intranasal administration of diazepam aiming at the treatment of acute seizures: clinical trials in healthy volunteers. , 1999, Biological & pharmaceutical bulletin.

[7]  L. Sun,et al.  A Double-Peak Phenomenon in the Pharmacokinetics of Alprazolam after Oral Administration , 1999 .

[8]  J. Bond Some biotransformation enzymes responsible for polycyclic aromatic hydrocarbon metabolism in rat nasal turbinates: effects on enzyme activities of in vitro modifiers and intraperitoneal and inhalation exposure of rats to inducing agents. , 1983, Cancer research.

[9]  P. Jakobsen,et al.  Pharmacokinetics and bioavailability of intravenous and intramuscular lorazepam with an adjunct test of the inattention effect in humans. , 2009, Acta pharmacologica et toxicologica.

[10]  D. Greenblatt,et al.  Pharmacokinetics and bioavailability of intravenous, intramuscular, and oral lorazepam in humans. , 1980, Journal of pharmaceutical sciences.

[11]  G. Simpson,et al.  Efficacy of lorazepam and haloperidol for rapid tranquilization in a psychiatric emergency room setting , 1997, International clinical psychopharmacology.

[12]  Y. Chien,et al.  Nasal systemic drug delivery , 1989 .

[13]  J. Proost Wagner's exact Loo-Riegelman equation: the need for a criterion to choose between the linear and logarithmic trapezoidal rule. , 1985, Journal of pharmaceutical sciences.

[14]  F. Gengo,et al.  Pharmacokinetics and Pharmacodynamics of Midazolam After Intranasal Administration , 1997, Journal of clinical pharmacology.

[15]  D. Greenblatt Clinical Pharmacokinetics of Oxazepam and Lorazepam , 1981, Clinical pharmacokinetics.

[16]  I. Patel,et al.  Effects of Age, Gender and Oral Contraceptives on Intramuscular Midazolam Pharmacokinetics , 1988, Journal of clinical pharmacology.

[17]  R. Sams,et al.  Lorazepam concentrations in plasma following its intravenous and rectal administration in dogs. , 1998, Journal of veterinary pharmacology and therapeutics.

[18]  K. Hanaoka,et al.  The effects of age and gender on the optimal premedication dose of intramuscular midazolam. , 1998, Anesthesia and analgesia.

[19]  F. Naldi,et al.  Xenobiotic-metabolizing enzymes in human respiratory nasal mucosa. , 1991, Biochemical pharmacology.

[20]  S. Björkman,et al.  Pharmacokinetics of midazolam given as an intranasal spray to adult surgical patients. , 1997, British journal of anaesthesia.

[21]  S. Lau,et al.  Absorption of diazepam and lorazepam following intranasal administration , 1989 .

[22]  K. Yonkers,et al.  Gender differences in pharmacokinetics and pharmacodynamics of psychotropic medication. , 1992, The American journal of psychiatry.

[23]  W. Dubin,et al.  Haloperidol, lorazepam, or both for psychotic agitation? A multicenter, prospective, double-blind, emergency department study. , 1997, The American journal of emergency medicine.

[24]  E. Fuseau,et al.  Comparative clinical pharmacokinetics of single doses of sumatriptan following subcutaneous, oral, rectal and intranasal administration. , 1998, European journal of pharmaceutical sciences : official journal of the European Federation for Pharmaceutical Sciences.

[25]  J. A. Bond,et al.  Regional distribution of xenobiotic metabolizing enzymes in respiratory airways of dogs. , 1988, Drug metabolism and disposition: the biological fate of chemicals.