title: Safety assessment of encapsulated morphine delivered epidurally in a sustained-release multivesicular liposome preparation in dogs.
abstract: We have shown that the epidural (EPI) delivery of morphine encapsulated in multivesicular liposomes (DepoFoam drug delivery system) produces a sustained clearance of morphine and a prolonged analgesia. We have sought to subsequently determine the likelihood of deleterious effects on local tissue of repetitive epidural injections of this encapsulated morphine preparation (C0401). Beagle dogs were prepared according to protocol approved by the Institutional Animal Care and Use Committee under volatile general anesthesia with chronic lumbar EPI catheters and subcutaneous injection ports. Male and female dogs (three groups) received a total of 4 EPI injections at 8-day intervals of 3 mL of C0401 (10 mg/mL morphine) (N = 6), DepoFoam vehicle (N = 6), or 0.9% sodium chloride (N = 6). Following EPI-C0401, but not saline or DepoFoam vehicle, there were transient (< 72 hr) decreases in food consumption, arousal, hindlimb muscle tone, and body temperature. Heart rate was unaltered, but there were modest decreases in blood pressure and respiratory rate, which persisted for 24-72 hr after C0401. No persistent changes in sensory/motor function, body weight, or stool/urine production were observed. Cerebrospinal fluid, blood chemistry, and urinalysis performed at surgery and on the day of sacrifice (24 hr after the last dose) were within normal ranges. Gross pathology at necropsy was unremarkable. Spinal histopathology findings were judged to be minimal (e.g., modest pericatheter inflammation and fibrosis) and present in all dogs. However, a statistical trend in the rank order of pathology scores was noted (Saline < DepoFoam vehicle < C0401). Repeated EPI injection of C0401 at the maximum dose that could be administered (30 mg) resulted in moderate, transient behavioral and physiological effects after each injection, consistent with morphine administration, and a modest effect on cord histopathology. This level of pathology is reflected in the lack of change observed in cerebrospinal fluid and lack of neurological findings. These results suggest that C0401 is without significant pathological effects at this dose after repeated epidural delivery in dogs.
authors.affiliation: Department of Anesthesiology, University of California, San Diego, La Jolla 92093-0818, USA.
authors.forename: T L
authors.initials: TL
authors.lastname: Yaksh
authors.forename: J C
authors.initials: JC
authors.lastname: Provencher
authors.forename: M L
authors.initials: ML
authors.lastname: Rathbun
authors.forename: R R
authors.initials: RR
authors.lastname: Myers
authors.forename: H
authors.initials: H
authors.lastname: Powell
authors.forename: P
authors.initials: P
authors.lastname: Richter
authors.forename: F R
authors.initials: FR
authors.lastname: Kohn
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects* / Q000493:pharmacokinetics; D000818:Animals; D001143:Arousal / Q000187:drug effects; D001522:Behavior, Animal / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D001921:Brain / Q000378:metabolism / Q000473:pathology; D003692:Delayed-Action Preparations; D004285:Dogs; D004339:Drug Compounding; D016503:Drug Delivery Systems; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D008081:Liposomes; D008297:Male; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects* / Q000493:pharmacokinetics; D015656:Respiratory Mechanics / Q000187:drug effects; D013116:Spinal Cord / Q000378:metabolism / Q000473:pathology
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D008081:Liposomes; D009020:Morphine