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      Effects of common cold and concomitant administration of nasal decongestant on the pharmacokinetics and pharmacodynamics of nasal glucagon in otherwise healthy participants: A randomized clinical trial

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          Abstract

          Aims

          Nasal glucagon (NG) is a nasally‐administered glucagon powder, absorbed through the nasal mucosa, designed for treatment of severe hypoglycaemia. This study evaluated the safety, pharmacokinetics (PK) and pharmacodynamics (PD) of NG in otherwise healthy participants with common colds and after recovery from cold symptoms, with and without concomitant nasal decongestant.

          Materials and Methods

          This was a single‐centre, open‐label study. Cohort 1 participants (N = 18) received 2 doses of NG: one while experiencing nasal congestion and another after recovery from cold symptoms. Cohort 2 participants (N = 18), who also had colds with nasal congestion, received a single dose of NG 2 hours after treatment with the decongestant oxymetazoline. Total symptoms score and other safety measures were assessed before and after NG administration.

          Results

          NG was well tolerated, without serious adverse events. Common adverse events (transient lacrimation, nasal discomfort, rhinorrhea and nausea) were more frequent in both Cohorts 1 and 2 during nasal congestion. Glucagon levels peaked 18 minutes post‐dose and glucose levels peaked 30 to 42 minutes post‐dose in all groups. Nasal congestion, with or without concomitant nasal decongestant, did not significantly affect PK of NG. Although glucose AUECs 0‐t was different between Cohort 1 with nasal congestion and Cohort 2, glucose concentrations at 30 minutes appeared similar in all groups.

          Conclusions

          There were no clinically relevant differences in safety or PK/PD of NG associated with nasal congestion or concomitant administration of nasal decongestant, suggesting that NG can be used to treat severe hypoglycaemia in individuals experiencing nasal congestion.

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          Most cited references19

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          Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry.

          Few studies have assessed factors associated with severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) in adults with type 1 diabetes (T1D).
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            Intranasal drug delivery: how, why and what for?

            Over the recent decades the interest in intranasal delivery as a non-invasive route for drugs is increased.Since the nasal mucosa offers numerous benefits as a target tissue for drug delivery, a wide variety of therapeutic compounds may be administered intranasally for topic, systemic and central nervous system action. We have, herein, outlined the relevant aspects of nasal anatomy, physiology and histology, and the biological, physicochemical and pharmaceutical factors that must be considered during the process of discovery and development of nasal drugs as well as in their incorporation into appropriate nasal pharmaceutical formulations.
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              Nasal drug delivery--possibilities, problems and solutions.

              This paper discusses the problems associated with nasal drug delivery and how it is possible, sometimes by means of quite simple concepts, to improve transport across the nasal membrane. In this way it is feasible to deliver efficiently challenging drugs such as small polar molecules, peptides and proteins and even the large proteins and polysaccharides used in vaccines or DNA plasmids exploited for DNA vaccines. The transport of drugs from the nasal cavity directly to the brain is also described and examples of studies in man, where this has been shown to be feasible, are discussed. Recent results from Phase I/II studies in man with a novel nasal chitosan vaccine delivery system are also described. Finally, the author's thoughts about the future for nasal drug delivery are also depicted. Copyright 2002 Published by Elsevier Science B.V.
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                Author and article information

                Contributors
                guzman_cristina_b@lilly.com
                Journal
                Diabetes Obes Metab
                Diabetes Obes Metab
                10.1111/(ISSN)1463-1326
                DOM
                Diabetes, Obesity & Metabolism
                Blackwell Publishing Ltd (Oxford, UK )
                1462-8902
                1463-1326
                19 November 2017
                March 2018
                : 20
                : 3 ( doiID: 10.1111/dom.2018.20.issue-3 )
                : 646-653
                Affiliations
                [ 1 ] Eli Lilly and Company Indianapolis Indiana
                [ 2 ] Locemia Solutions Montréal Québec Canada
                [ 3 ] Algorithme Pharma Inc. Montréal Québec Canada
                [ 4 ] JSS Medical Research Montréal Québec Canada
                [ 5 ] Eli Lilly Canada Inc. Toronto Ontario Canada
                Author notes
                [*] [* ] Correspondence

                Cristina Guzman, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285.

                Email: guzman_cristina_b@ 123456lilly.com

                Article
                DOM13134
                10.1111/dom.13134
                5836949
                29053231
                2f3afddf-e9f5-4f17-858d-91376134aa42
                © 2017 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 26 May 2017
                : 25 September 2017
                : 14 October 2017
                Page count
                Figures: 2, Tables: 3, Pages: 8, Words: 5593
                Funding
                Funded by: Locemia Solutions, Montréal, Québec, Canada
                Funded by: Eli Lilly and Company
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                dom13134
                March 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.3.2.2 mode:remove_FC converted:05.03.2018

                Endocrinology & Diabetes
                glucagon,hypoglycaemia
                Endocrinology & Diabetes
                glucagon, hypoglycaemia

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