title: Buccal acetaminophen provides fast analgesia: two randomized clinical trials in healthy volunteers.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France ; Inserm, Clermont-Ferrand, France ; Clermont Université, Laboratoire de Pharmacologie, Faculté de Médecine, Clermont-Ferrand, France.
authors.forename: Gisèle
authors.initials: G
authors.lastname: Pickering
authors.affiliation: CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Macian
authors.affiliation: Inserm, Clermont-Ferrand, France ; Laboratoire de Pharmacologie, CHU Clermont-Ferrand, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Libert
authors.affiliation: CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France.
authors.forename: J Michel
authors.initials: JM
authors.lastname: Cardot
authors.affiliation: CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France.
authors.forename: Séverine
authors.initials: S
authors.lastname: Coissard
authors.affiliation: Unither Pharamceuticals, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Perovitch
authors.affiliation: Unither Pharamceuticals, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Maury
authors.affiliation: CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France ; Inserm, Clermont-Ferrand, France ; Clermont Université, Laboratoire de Pharmacologie, Faculté de Médecine, Clermont-Ferrand, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Dubray
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage* / Q000097:blood / Q000494:pharmacology*; D000278:Administration, Buccal; D000328:Adult; D000698:Analgesia; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D013997:Time Factors
chemical_list: D000082:Acetaminophen
keywords: healthy volunteer; pain; transmucosal delivery