Intravenous versus intramuscular route: How to choose

Publication date: December 2009 Source:Digestive and Liver Disease Supplements, Volume 3, Issue 4 Author(s): S. Fagiuoli , L. Pasulo End-stage liver diseases due to HBV are among the major indications for liver transplantation worldwide and represent a peculiar issue in Italy where they can be as high as 25%. The widespread use of long-term prophylaxis with hepatitis B immunoglobulin (HBIG), either alone or in combination with antiviral drugs in the post-liver transplant period, has significantly improved both graft and patient survival. HBIG prophylaxis is usually administered intravenously, or intramuscularly The two formulations present a peculiar difference in their pharmacokynetics: peak serum concentrations after intravenous administration are observed within 2 hours, whereas intramuscular injection of HBIG provides peak serum concentrations between day 5 and 11. However, long-term intravenous prophylaxis is expensive and time-consuming. In order to determine when and how to choose between intravenous or intramuscular route, the anhepatic phase is crucial for the potential risk of graft infection and for which a management strategy that specifically addresses the virological status and history of the patient should be adopted. During the first week post-transplantation, high-dose protocols are traditionally applied, although the ideal, patient-tailored protocols should be defined on the basis of both viral and patient-related features. After the first week post-tr...
Source: Digestive and Liver Disease Supplements - Category: Gastroenterology Source Type: research