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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/03/21 09:05:15」(JST)

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Intrathecal administration is a route of administration for drugs via an injection into the spinal canal, more specifically into the subarachnoid space so that it reaches the cerebrospinal fluid (CSF) and is useful in spinal anaesthesia, chemotherapy, or pain management applications. This route is also used to introduce drugs that fight certain infections, particularly post-neurosurgical. The drug needs to be given this way to avoid the blood brain barrier. The same drug given orally must enter the blood stream and may not be able to pass out and into the brain. Drugs given by the intrathecal route often have to be made up specially by a pharmacist or technician because they cannot contain any preservative or other potentially harmful inactive ingredients that are sometimes found in standard injectable drug preparations.

The route of administration is sometimes simply referred to as "intrathecal"; however, the term is also an adjective that refers to something occurring in or introduced into the anatomic space or potential space inside a sheath, most commonly the arachnoid membrane of the brain or spinal cord^[1] (under which is the subarachnoid space). For example, intrathecal immunoglobulin production is production of antibodies in the spinal cord.^[2] The abbreviation "IT" is best not used; instead, "intrathecal" is spelled out to avoid medical mistakes.

Intrathecal administration of analgesic agents

Very popular for a single 24-hour dose of analgesia (opioid with local anesthetic)
Caution because of late onset hypoventilation
Severe pruritus and urinary retention may limit the use of intrathecal morphine
Pethidine has the unusual property of being both a local anaesthetic and opioid analgesic which occasionally permits its use as the sole intrathecal anaesthetic agent

Intrathecal chemotherapy

Currently, only four agents are licensed for intrathecal chemotherapy
- They are methotrexate, cytarabine (Ara-C), hydrocortisone, and, rarely, thiotepa.^[3]
Administration of other chemotherapeutic agents such as vincristine via the intrathecal route can lead to fatal outcomes.^[4]^[5]

Intrathecal baclofen

Often reserved for spastic cerebral palsy, intrathecally-administered baclofen is done through an intrathecal pump implanted just below the skin of the stomach, (or behind the chest wall, depending on the surgeon implanting the device, and patient preferences), with a tube (called the 'catheter') connected directly to the base of the spine, where it bathes the spinal cord using a dose about one thousand times smaller than that required by orally-administered baclofen. Intrathecal baclofen also carries none of the side effects, such as sleepiness, that typically occur with oral baclofen. However, intrathecal baclofen pumps carry serious clinical risks, such as infection or a possibly fatal sudden malfunction, that oral baclofen does not.

A tremendous amount of care is taken to ensure the optimal location of the pump and catheter, based upon medical considerations and patient requirements.

References

^ "Route of Administration". Data Standards Manual. Food and Drug Administration. Retrieved 11 March 2011.
^ Meinl, E; Krumbholz, M; Derfuss, T; Junker, A; Hohlfeld, R (2008). "Compartmentalization of inflammation in the CNS: a major mechanism driving progressive multiple sclerosis". Journal of the neurological sciences 274 (1–2): 42–4. doi:10.1016/j.jns.2008.06.032. PMID 18715571.
^ Grossman SA, Finklestein DM, Ruckdeschel JC, et al. (March 1993). "Randomized prospective comparison of intraventricular methotrexate and thiotepa with previously untreated neoplastic meningitis. Eastern Cooperative Oncology Group.". Journal of Clinical Oncology 11 (3): 561–9. PMID 8445432.
^ Schulmeister L (September 2004). "Preventing vincristine sulfate medication errors". Oncology Nursing Forum 31 (5): E90–8. doi:10.1188/04.ONF.E90-E98. PMID 15378106.
^ Qweider M, Gilsbach JM, Rohde V (March 2007). "Inadvertent intrathecal vincristine administration: a neurosurgical emergency. Case report". Journal of Neurosurgery. Spine 6 (3): 280–3. doi:10.3171/spi.2007.6.3.280. PMID 17355029.

UpToDate Contents

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English Journal

Beneficial properties of maraviroc on neuropathic pain development and opioid effectiveness in rats.

Kwiatkowski K1, Piotrowska A1, Rojewska E1, Makuch W1, Jurga A1, Slusarczyk J2, Trojan E2, Basta-Kaim A2, Mika J3.
Progress in neuro-psychopharmacology & biological psychiatry.Prog Neuropsychopharmacol Biol Psychiatry.2016 Jan 4;64:68-78. doi: 10.1016/j.pnpbp.2015.07.005. Epub 2015 Jul 16.
Targeting chemokine signaling pathways is crucial in neuropathy development. In this study, we investigated the influence of chronic administration of maraviroc (CCR5 antagonist) on nociception and opioid effectiveness during neuropathy, which develops as a result of chronic constriction injury (CCI
PMID 26190414

Efficient Gene Suppression in Dorsal Root Ganglia and Spinal Cord Using Adeno-Associated Virus Vectors Encoding Short-Hairpin RNA.

Enomoto M1,2, Hirai T3,4, Kaburagi H5, Yokota T6.
Methods in molecular biology (Clifton, N.J.).Methods Mol Biol.2016;1364:277-90. doi: 10.1007/978-1-4939-3112-5_22.
RNA interference is a powerful tool used to induce loss-of-function phenotypes through post-transcriptional gene silencing. Small interfering RNA (siRNA) molecules have been used to target the central nervous system (CNS) and are expected to have clinical utility against refractory neurodegenerative
PMID 26472458

Intrathecal fentanyl blockade of afferent neural feedback from skeletal muscle during exercise in heart failure patients: Influence on circulatory power and pulmonary vascular capacitance.

Van Iterson EH1, Snyder EM2, Joyner MJ3, Johnson BD3, Olson TP3.
International journal of cardiology.Int J Cardiol.2015 Dec 15;201:384-93. doi: 10.1016/j.ijcard.2015.08.101. Epub 2015 Aug 14.
BACKGROUND: Secondary pulmonary hypertension is common in heart failure (HF) patients. We hypothesized that inhibition of feedback from locomotor muscle group III/IV neurons contributes to reduced pulmonary vascular pressures independent of changes in cardiac function during exercise in HF.METHODS:
PMID 26310984

Japanese Journal

Pharmacology : Effect of cyclosporin on distribution of methotrexate into the brain of rats

The journal of veterinary medical science 77(9), 1171-1173, 2015-09
NAID 40020611337

Hepatocyte growth factor and Met in drug discovery

The journal of biochemistry 157(5), 271-284, 2015-05
NAID 120005647661

バクロフェン髄腔内投与療法(ITB療法;intrathecal baclofen therapy) (特集痙縮治療の実際 : 評価・手技・リハビリテーション)

Monthly book medical rehabilitation (180), 51-58, 2015-02
NAID 40020388864

Related Pictures

★リンクテーブル★

リンク元	「IT」「髄腔内」「くも膜下腔内」
拡張検索	「intrathecally」「intrathecal injection」「intrathecal therapy」

「IT」

Subarachnoid space
	Diagrammatic representation of a section across the top of the skull, showing the membranes of the brain, etc. ("Subarachnoid cavity" visible at left.)
	Diagrammatic transverse section of the medulla spinalis and its membranes. (Subarachnoid cavity colored blue.)
Details
Identifiers
Latin	Spatium subarachnoideum,; cavum subarachnoideale
MeSH	A08.186.566.166.686
Dorlands; /Elsevier	s_16/12746651
	Anatomical terminology [edit on Wikidata]