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{{Short description|Drug injected into the spinal canal}}
'''Intrathecal administration''' is a [[route of administration]] for drugs via an [[injection (medicine)|injection]] into the [[spinal canal]], or into the [[subarachnoid space]] so that it reaches the [[cerebrospinal fluid]] (CSF) and is useful in [[spinal anesthesia]], [[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 being stopped by 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 compounded 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]]<ref>{{cite web|title=Route of Administration|url=http://www.fda.gov/Drugs/DevelopmentApprovalProcess/FormsSubmissionRequirements/ElectronicSubmissions/DataStandardsManualmonographs/ucm071667.htm|work=Data Standards Manual|publisher=Food and Drug Administration|accessdate=11 March 2011}}</ref> (under which is the [[subarachnoid space]]). For example, intrathecal immunoglobulin production is production of antibodies in the spinal cord.<ref>{{cite journal | last1 = Meinl | first1 = E | last2 = Krumbholz | first2 = M | last3 = Derfuss | first3 = T | last4 = Junker | first4 = A | last5 = Hohlfeld | first5 = R | title = Compartmentalization of inflammation in the CNS: a major mechanism driving progressive multiple sclerosis | journal = Journal of the Neurological Sciences | volume = 274 | issue = 1–2 | pages = 42–4 | year = 2008 | pmid = 18715571 | doi = 10.1016/j.jns.2008.06.032 }}</ref> The abbreviation "IT" is best not used; instead, "intrathecal" is spelled out to avoid medical mistakes.▼
{{Infobox anatomy
| Name = Subarachnoid space
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▲'''Intrathecal administration''' is a [[route of administration]] for drugs via an [[injection (medicine)|injection]] into the [[spinal canal]], or into the [[subarachnoid space]] so that it reaches the [[cerebrospinal fluid]] (CSF).
Intrathecal pseudodelivery is a technique where the drug is encapsulated in a porous capsule that is placed in communication with the cerebrospinal CSF. In this method, the drug is not released into the CSF. Instead, the CSF is in communication with the capsule through its porous walls, allowing the drug to interact with its target within the capsule itself. This allows for localized treatment while avoiding systemic distribution of the drug, potentially reducing side effects and enhancing the therapeutic efficacy for conditions affecting the central nervous system.
▲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]]<ref>{{cite web|title=Route of Administration|url=
==Applications of intrathecal administration==
=== Analgesics ===
Intrathecal administration is often used for a single 24-hour dose of analgesia ([[opioid]] with [[local anesthetic]]). Caution should be exercised with intrathecal opioids due to the risk of late onset [[hypoventilation]]. The use of intrathecal [[morphine]] may be limited by severe [[itch|pruritus]] and [[urinary retention]].{{Citation needed|date=May 2024}}
=== Antifungals ===
[[Amphotericin B]] is administered intrathecally to treat fungal infections involving the central nervous system infections.<ref name="PMID32349999">{{cite journal |last1=Nau |first1=R |last2=Blei |first2=C |last3=Eiffert |first3=H |title=Intrathecal Antibacterial and Antifungal Therapies. |journal=Clinical Microbiology Reviews |date=17 June 2020 |volume=33 |issue=3 |doi=10.1128/CMR.00190-19 |pmid=32349999|pmc=7194852 }}</ref>
▲*[[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
▲* An intrathecal catheter and pump can be used to deliver a local anaesthetic and sometimes also an opioid and/or [[clonidine]].
=== Baclofen ===
▲==Intrathecal chemotherapy==
Often reserved for [[spastic
▲**They are [[methotrexate]], [[cytarabine]] (Ara-C), [[hydrocortisone]], and, rarely, [[thiotepa]].<ref name="pmid8445432">{{cite journal |vauthors=Grossman SA, Finklestein DM, Ruckdeschel JC, etal | title = Randomized prospective comparison of intraventricular methotrexate and thiotepa with previously untreated neoplastic meningitis. Eastern Cooperative Oncology Group. | journal = Journal of Clinical Oncology | volume = 11 | issue = 3 | pages = 561–9 |date=March 1993 | pmid = 8445432 | doi=10.1200/jco.1993.11.3.561}}</ref>
▲*Administration of other chemotherapeutic agents such as [[vincristine]] via the intrathecal route can lead to fatal outcomes.<ref name="pmid15378106">{{cite journal | author = Schulmeister L | title = Preventing vincristine sulfate medication errors | journal = Oncology Nursing Forum | volume = 31 | issue = 5 | pages = E90–8 |date=September 2004 | pmid = 15378106 | doi = 10.1188/04.ONF.E90-E98 | url = }}</ref><ref name="pmid17355029">{{cite journal |vauthors=Qweider M, Gilsbach JM, Rohde V | title = Inadvertent intrathecal vincristine administration: a neurosurgical emergency. Case report | journal = Journal of Neurosurgery. Spine | volume = 6 | issue = 3 | pages = 280–3 |date=March 2007 | pmid = 17355029 | doi = 10.3171/spi.2007.6.3.280 | url = }}</ref>
=== Mesenchymal Stem Cell Therapy===
Treatment of chronic spinal injuries via the administration of [[mesenchymal stem cells]],<ref>{{Cite journal |last1=Li |first1=Man |last2=Chen |first2=Hong |last3=Zhu |first3=Mingxin |date=2022-12-13 |title=Mesenchymal stem cells for regenerative medicine in central nervous system |journal=Frontiers in Neuroscience |language=English |volume=16 |doi=10.3389/fnins.2022.1068114 |doi-access=free |pmid=36583105 |issn=1662-453X|pmc=9793714 }}</ref> either from adipose tissue or bone marrow, is experimental, with better results from the former method. Introduction of mesenchymal stem cells promote the microenvironment needed for axonal regrowth and reduction of inflammation caused by astrocytes proliferation and glial scar tissue.<ref>{{Cite journal |last1=Carrillo-Galvez |first1=Ana Belén |last2=Cobo |first2=Marién |last3=Cuevas-Ocaña |first3=Sara |last4=Gutiérrez-Guerrero |first4=Alejandra |last5=Sánchez-Gilabert |first5=Almudena |last6=Bongarzone |first6=Pierpaolo |last7=García-Pérez |first7=Angélica |last8=Muñoz |first8=Pilar |last9=Benabdellah |first9=Karim |last10=Toscano |first10=Miguel G. |last11=Martín |first11=Francisco |last12=Anderson |first12=Per |date=2015-01-01 |title=Mesenchymal Stromal Cells Express GARP/LRRC32 on Their Surface: Effects on Their Biology and Immunomodulatory Capacity |journal=Stem Cells |language=en |volume=33 |issue=1 |pages=183–195 |doi=10.1002/stem.1821 |issn=1066-5099 |pmc=4309416 |pmid=25182959 |doi-access=free}}</ref>
▲Often reserved for [[spastic]] [[cerebral palsy]], intrathecally-administered [[baclofen]] is done through an [[intrathecal pump]] implanted just below the skin of the abdomen, (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.
Animal models have showed improved motor control under the site of injury. A clinical trial also showed statistically significant improved sensitivity under the site of injury in patients.<ref>{{Cite journal |last1=Vaquero |first1=Jesús |last2=Zurita |first2=Mercedes |last3=Rico |first3=Miguel A. |last4=Aguayo |first4=Concepcion |last5=Bonilla |first5=Celia |last6=Marin |first6=Esperanza |last7=Tapiador |first7=Noemi |last8=Sevilla |first8=Marta |last9=Vazquez |first9=David |last10=Carballido |first10=Joaquin |last11=Fernandez |first11=Cecilia |last12=Rodriguez-Boto |first12=Gregorio |last13=Ovejero |first13=Mercedes |last14=Vaquero |first14=Jesús |last15=Zurita |first15=Mercedes |date=2018-06-01 |title=Intrathecal administration of autologous mesenchymal stromal cells for spinal cord injury: Safety and efficacy of the 100/3 guideline |url=https://www.sciencedirect.com/science/article/pii/S1465324918304717 |journal=Cytotherapy |volume=20 |issue=6 |pages=806–819 |doi=10.1016/j.jcyt.2018.03.032 |pmid=29853256 |issn=1465-3249|doi-access=free }}</ref>
==See also==
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