BME 372 Modern Drug Transport Systems

IONTOPHERESIS

By

BÜŞRA PELİN DURAN - İPEK NUR GÖKMEN

Department of Biomedical Engineering

Faculty of Engineering

Yeditepe University
Istanbul, Turkey
MAY2021
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ABSTRACT

IONTOPHORESIS

In this assignment in the BME 372 Modern Drug Transport Systems course, we
learned the working principle of iontophoresis. Since we know that iontophoresis is a
important part of sweating and tendonitis treatments since early 1700’s, it becomes more
and more developed. This is a transdermal drug delivery system which uses electric current
to deliver ions into tissues and thats why it can be classified as an iontophoretic treatment.
To understand this treatment it is neccesary to know how this system works through and
electric current and which medications is used. The important points such as working
principles, technical properties (electrode choice and size, types of medications and
solutions etc.), application steps and commonly used systems take part on this research. By
understanding iontophoresis any of the iontophoretic treatment technologies can be
developed properly in biomedical engineering.
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ÖZET

İYONTOFOREZ

Bu araştırma BME372 Modern İlaç Taşıyıcı Sistemler dersinde öğrenilen iyontoforez

sisteminin detaylandırılmasını amaçlamaktadır. İyontoforezin terleme ve tendon problemle-
rinde 1700’lü yılların başından beri kullanılıyor olmasından bu yana oldukça geliştiğini bi-
liyoruz. Bu sistem iyonların dokulara elektrik akımı yardımıyla iletildiği bir transdermal ilaç
taşıyıcı sistemdir. İyontoforetik bir yöntem olması bu özelliğinden gelmektedir. Tedaviyi daha
iyi anlamak için öncelikle sistemin nasıl çalıştığı, elektrik akımının bu sistemdeki rolü ve hangi
tedavilerde hangi çözeltilerin kullanıldığı, gerekli tedavi için hangi etken maddenin dokuya
gönderildiği gibi temel bilgilere hakim olmak gerekmektedir. Bu araştırmada siste-min çalışma
prensipleri, teknik özellikler (elektrot seçimi ve ilaç türleri vs.), tedavinin uy-gulanmasında
izlenecek adımlar ve yaygın kullanılan sistemler yer almaktadır. Biyomedikal mühendisliğinde
bu alanda yapılacak yeniliklerin ve geliştirmelerin geleceği iyontoforetik tedavi yöntemlerini
iyi anlamaktan geçmektedir.
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TABLE OF CONTENTS

ABSTRACT ................................................................................................................................................. ii

ÖZET ............................................................................................................................................................ iii

LIST OF FIGURES .................................................................................................................................. iii

1. WHAT IS IONTOPHORESIS? ....................................................................................................... 1

1.1.IONTOPHORESİS VS PHONOPHORESIS…………………………………….. 2

1.2.HOW DOES IT WORK?……………………………………………………………3

1.3.IN WHICH DISEASES IS IT USED?

.......................................................................4
.

1.3.1. SWEATING PROBLEM………………………………………………..4

1.3.2. TENDONITIS PROBLEM………………………………………. …….4

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2.BASIC PRINCIPLES…………………………………………………………………5

2.1.CURRENT REQUIRED………………………………………………………..5

2.1.1.ALTERNATIVE CURRENT……………………………………………6

2.1.2.DISTANCE BETWEEN TWO ELECTRODES…………………………7

2.2.IONIC POLARITY……………………………………………………………..7

2.2.1.SOLUTIONS(ÇÖZELİLER)…………………………………………….7

2.3.LOW-LEVEL AMPLITUDE………………………………………………… 8

2.4.ELECTRODE SIZE……………………………………………………………8

2.4.1.ELECTRODE CHOICE-SIZE…………………………………………8

3.ELECTRODE TYPES………………………………………………………………..9

3.1.TRADITIONAL ELECTRODES…………………………………………….9

3.2.COMMERCIAL ELECTRODES………………………………………………9

4.ELECTRODE PREPERATION………………………………………………………10

5.COMMERCIALLY DEVELOPED IONTOPHORETIC DELIVERY SYSTEMS……10.

5.1.LIDOSITE……………………………………………………………………….10.

5.2.PHORESOR II………………………………………………………………10

5.3.E-TRANS…………………………………………………………………….10

5.4.PHORESOR………………………………………………………………….10

6.SIDE EFFECTS………………………………………………………………………11

REFERENCES .................................................................................................................................... 11
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LIST OF FIGURES

Figure 1.1. Plantar Hiperhidroz .....................................................................................….1

Figure 1.1.1. Palmar Hiperhidroz................................................……. ….………………..2

Figure 1.2.1. Working mechanism……………………………………………………... ..3

Figure 1.3.2.1. Operative Image…………………………………………………………..5

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1. WHAT IS IONTOPHORESIS?

Iontophoresis is a process of transdermal drug delivery by use of a voltage gradient

on the skin. Molecules are transported across the stratum corneum by electrophoresis and
electroosmosis and the electric field can also increase the permeability of the skin.These
phenomena, directly and indirectly, constitute active transport of matter due to an applied
electric current. The transport is measured in units of chemical flux, commonly
μmol/(cm2*hour). Iontophoresis has experimental, therapeutic and diagnostic applications.

The term iontophoresis simply defined as an ion transfer (ionto=ion ;

phoresis=transfer)

Figure 1.1. Plantar Hiperhidroz

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1.1. IONTOPHORESİS VS PHONOPHORESIS

Iontophoresis uses electrical current to transport ions into tissues.

Phonophoresis uses acoustic enegy (ultrasound) to drive molecules into tissue.

Figure 1.1.1. Palmar Hiperhidroz

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1.2. HOW DOES IT WORK?

Figure 1.2.1. Working mechanism

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1.3. IN WHICH DISEASES IS IT USED?

-SWEATING PROBLEM

-TENDONITIS PROBLEM

1.3.1. SWEATING PROBLEM

Iontophoresis is a safe and effective treatment that can be used to reduce excessive swea-
ting (hyperhidrosis) of the hands, feet, underarms and face (if the necessary attachment is
available to go onto the machine).

1.3.2. TENDONITIS PROBLEM

At BioMechanic Physical Therapy our techniques are founded in your body’s

mechanics; from when your foot hits the ground then up through your knees, hips and
beyond. A common example is when over pronation in the foot causes knee pain. Maybe
you just need new shoes – not a knee operation.
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Figure 1.3.2.1. Operative Image

2.BASIC PRINCIPLES

-Current Required
-Ionic Polarity
-Low-level Amplitude
-Electrode Size

2.1.CURRENT REQUIRED

In order to ‘drive’ the ions into the tissues,a DIRECT(Galvanic) CURRENT needs to em-
ployed.A monophasic pulsed application can also be used.
Constant current is preferable to constant voltage-thus,the magnitude of the applied
current will not exceed the present level in terms of skin resistance.
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2.1.1.ALTERNATIVE CURRENT

Although direct current is generally used in iontophoresis treatment, alternating current,

which is a type of pulse current, has also been used. In one of the studies using
iontophoresis using alternating current, it was reported that the hyperhidrosis complaints of
the patients decreased significantly after 3 sessions, in another study, it was observed that
both the average amount of sweat and sodium concentration in sweat decreased
significantly after 6 sessions, and the alternating current was effective with a different and
more complicated mechanism than direct current. It has been reported.

In a study where the placebo effect of iontophoresis was also investigated, patients with
palmoplantar hyperhidrosis were given low intensity alternating current as placebo first.
(9-12 mAmp, 10-15V, 8-10 Hz), then direct current (18-22 mAmp, 40-60V) was applied
for the same time and it was observed that the intensity of sweat was significantly reduced
(p<0.001) compared to placebo,and iontophoresis was reported to have no placebo effect.

Extra: What alternative treatments is it used for?

1) Interferential Therapy

2) Pre-Modulated Therapy (More effective)

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2.1.2.DISTANCE BETWEEN TWO ELECTRODES

In this method; The drug to be applied is absorbed into a cotton ball and an electrode is
attached to it. This electrode is set on the device as positive or negative, the opposite of the
charge it will receive when the drug is ionized. Electrode-attached cotton is placed in the
area to deliver the drug. The other electrode can be applied to another area (15-20 cm in the
arm or leg for application, to the lip for intraoral applications, to complement the electric
current). on the cheek ...). With the philosophy of "same poles repel each other, opposite
poles attract each other" by applying a small current such as 0.5 mA / cm2, the drug passes
through the skin a little.

2.2.IONIC POLARITY

The basis of successful ion transfer lies in physics principle “like poles repel and unlike
poles attract”
Ions with polarity which is the same as that of the stimulating electrode are repelled into
the skin
The electrode under which the ionic solution is placed is called the ACTIVE electrode
The other electrode,which is used to complete the circuit is most commonly called the
DISPERSIVE,INDIFFERENT,INACTIVE or RETURN electrode.

2.2.1.SOLUTIONS(ÇÖZELİLER)

Although tap water is generally used in iontophoresis treatment, anti-cholinergic drugs are
also used to be more effective. Addition of anticholinergic agents such as glycopyranium
bromide, poldin methyl sulfate, helisopyranium bromide and glycopyrrolate to tap water
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enables the effects of iontophoresis to occur faster and last longer. However, such as dry
mouth, adjustment disorders, urinary retention or abdominal pain Since systemic side
effects can be seen, it is recommended to start treatment with tap water iontophoresis first
and add anticholinergics if no response is obtained. Iontophoresis with saline solution was
also tried in the treatment of hyperhidrosis, but it was found to be ineffective. Botulinum
toxin, which is used as intradermal injections in the treatment of local hyperhidrosis, was
applied by iontophoresis to prevent its side effects and it has been shown to reduce
sweating without causing pain, muscle weakness and compensatory hyperhydrosis.

2.3.LOW-LEVEL AMPLITUDE

-Low-level amplitude is more effective

-The treatment is usually applied with currents up to 5mA
With low ionşc concentrations-up to 5%
Treatment times are typically in the 10-30 minute range.

2.4.ELECTRODE SIZE

2.4.1.ELECTRODE CHOICE-SIZE

Size and shape of electrodes can cause variation in current density. To prevent this, a
selection of electrode matters. While the most common electrode is silver chloride to prevent
hydrolysis,platinum, silver and aliminum foil is also used for iontophoretic drug delivery.To
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mention about size of electrodes, the negative electrode should be larger than the positive
one.There are two types of electrode, traditional and commercial electrodes.Traditional
electrodes are made of tin, copper, lead, aliminum and platinum backed by rubber.Surfaces
which contacts skin are completely covered by sponge, towel or gauze. The absorbent
material is soaked by medicaiton/solution. Commercial electrodes sold with most whole
system of ionthophoresis. Electrones have small chamber covered by a semipermeable
membrane into which ionized solution may be injected.

3.ELECTRODE TYPES

-TRADITIONAL ELECTRODES

-.COMMERCIAL ELECTRODES

3.1.TRADITIONAL ELECTRODES

-Made of tin, copper, lead, aliminum or platinum backed by rubber.

-Completely covered by sponge, towel or gauze which contacts skin.
-Absorbent material is soaked with ionized solution (medication).

3.2.COMMERCIAL ELECTRODES

-Sold with most iontophoresis systems.

-Electrons have small chamber covered by a semipermeable membrane into which
ionized solution may be injected.
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4.ELECTRODE PREPERATION

Enlarging the negative electrode size lowers the current density on the negative pad,
leading the reduction of irritation. Self-adhering active electrode must be attached to the
skin. Ionized solution must be injected into the chamber. Last step is self adhering inactive
electrode must be attached to the skin and lead wires from the generator.

5.COMMERCIALLY DEVELOPED IONTOPHORETIC DELIVERY SYSTEMS

-LIDOSITE

-PHORESOR II

-E-TRANS

-PHORESOR

5.1.Lidosite® To deliver lidocaine. Lidocaine is an anesthesic agent.

5.2.Phoresor®II To deliver botulinum molecule which is used fort he treatment of

hyperhydrosis.

5.3.E-trans® To deliver fentanyl. Fentanyl is an opioid analgesic which is 80 times stronger

than morphine.
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5.4.Phoresor® To deliver iontocaine which is an anesthesic agent.

6.SIDE EFFECTS

The most common side effect is dryness of the skin. Blistering, peeling,
and irritation might also occur on the skin. It can be repaired by using moisturizer cream
simply.

REFERENCES

1)https://jag.journalagent.com/medeniyet/pdfs/ MEDJ_26_2_78_82.pdf

2)SlideShare.net

3)https://www.serafettinsaracoglu.com/blogdetayterleme-tedavisinde-iyontoforez-30
4)https://www.uzmandoktor.net/iyontoforez

5)https://www.terleme.com.tr/iyontoforez-ile-asiriterleme-tedavisi-2/
6)https://ankara.baskenthastaneleri.com/tr/tibbibolumlerimiz/deri-ve-zuhrevi-hastaliklari-
dermatolojianabilim-dali/asiri-terleme-tedavisi
7)http://nek.istanbul.edu.tr:4444/ekos/TEZ/49596.pdf

8)ttps://youtu.be/AjwxdmKIW6c

9)The use of Iontophoresıs in Tendonitis

https://www.youtube.com/watch?v=7CvU0oyfWnU