A iontoforese na prática fisioterapêutica
DOI:
https://doi.org/10.33233/fb.v8i6.1817Abstract
Contextualização: A iontoforese é uma técnica que usa corrente galvânica para aumentar a transferência transdermal de fármacos ionizáveis de maneira controlada, segura e sem desconforto sensorial. Assim como outras modalidades, existem poucos estudos clínicos bem documentados que contribuam para prática baseada em evidências em condições comuns na prática fisioterapêutica. No entanto, alguns estudos clínicos randomizados e controlados, estudos não controlados e casos clínicos disponíveis descrevem resultados favoráveis ao tratamento de condições inflamatórias osteomioarticulares e calcificações ectópicas. Objetivos: Propor um roteiro de tomada de decisão clínica e discutir aspectos relevantes para prática adequada para garantir os resultados terapêuticos desejados. Métodos: Foram revisados estudos clínicos, estudos clínicos randomizados e controlados, estudos de casos, artigos de revisão e livros texto de eletroterapia. Resultados: São apresentados os íons e fármacos ionizáveis que possuem mecanismos de ação em condições relacionadas í fisioterapia, a técnica de aplicação, as complicações, cuidados e reações adversas. Também são discutidas as vantagens e as limitações da aplicação de iontoforese. Conclusão: Este artigo de revisão oferece o embasamento teórico para aplicação da iontoforese na prática da fisioterapia.
Palavras-chave: iontoforese, fisioterapia, aplicação medicamentosa transdermal, eletroterapia, corrente galvânica.
References
Barry BW. Novel mechanisms and devices to enable successful transdermal drug delivery. Eur J Pharm Sci 2001;14:101-14.
Kalia YN, Naik A, Garrison J, Guy RH. Iontophoretic drug delivery. Adv Drug Deliv Rev 2004 27;56:619-58.
Nirschl RP, Rodin DM, Ochiai DH, Maartmann-Moe C, DEX-AHE-01-99 Study Group. Iontophoretic administration of dexamethasone sodium phosphate for acute epicondylitis. A randomized, double-blinded, placebo-controlled study. Am J Sports Med 2003;31:189-95.
Baskurt F, Ozcan A, Algun C. Comparison of effects of phonophoresis and iontophoresis of naproxen in the treatment of lateral epicondylitis. Clin Rehabil 2003;17:96-100.
Behar-Cohen FF, El Aouni A, Gautier S, David G, Davis J, Chapon P, Parel JM. Transscleral Coulomb-controlled iontophoresis of methylprednisolone into the rabbit eye: influence of duration of treatment, current intensity and drug concentration on ocular tissue and fluid levels. Exp Eye Res 2002;74:51-9.
Curdy C, Kalia YN, Naik A, Guy RH. Piroxicam delivery into human stratum corneum in vivo: iontophoresis versus passive diffusion. J Control Release 2001; 11;76(1-2):73-9.
Fang J, Wang R, Huang Y, Wu PC, Tsai Y. Passive and iontophoretic delivery of three diclofenac salts across various skin types. Biol Pharm Bull 2000;23:1357-62.
Gudeman SD, Eisele SA, Heidt RS Jr, Colosimo AJ, Stroupe AL. Treatment of plantar fasciitis by iontophoresis of 0.4% dexamethasone. A randomized, double-blind, placebo-controlled study. Am J Sports Med 1997;25:312-6.
Schiffman EL, Braun BL, Lindgren BR. Temporomandibular joint iontophoresis: a double-blind randomized clinical trial. J Orofac Pain 1996;10:157-65.
Reid KI, Dionne RA, Sicard-Rosenbaum L, Lord D, Dubner RA. Evaluation of iontophoretically applied dexamethasone for painful pathologic temporomandibular joints. Oral Surg Oral Med Oral Pathol 1994;77:605-9.
Salli L. Efficacy and tolerability of ketoprofene administered through iontophoresis in rheumatoid arthritis. Results from a multicentric study. Clin Ther 1993;142:533-7.
Morimoto M, Hakuto T, Morimoto E, Kato H, Iwasaku K, Kurioka M, Hyodo M. Iontophoretic administration of indomethacin in the treatment of postherpetic neuralgia. Masui 1991;40:1256-60
Zempsky WT, Sullivan J, Paulson DM, Hoath SB. Evaluation of a low-dose lidocaine iontophoresis system for topical anesthesia in adults and children: a randomized, controlled trial. Clin Ther 2004;26:1110-9.
Oliveira AS, Guaratini MI, Castro CES. Fundamentação teórica para iontoforese. Rev Bras Fisioter 2005;9:1-7.
Green S, Higgins J, editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.5. [citado 2005 nov 1]. DisponÃvel em URL: http://www.cochrane.dk/cochrane/handbook/handbook.htm.
Altman DG. Better reporting of randomised controlled trials: the CONSORT statement. BMJ 1996;313:570-1.
Psaki CG, Carroll J. Acetic acid ionization: a study to determine the absorptive effects upon calcified tendonitis of the shoulder. Phys Ther Rev 1955;35:84-87.
Taccola A, Zambelli M. Considerations on pulsoplethysmographic changes in fingers due to iontophoresis with methacholine in subjects with Raynaud's phenomenon. Minerva Cardioangiol 2000;48:137-46.
Código de ética profissional de fisioterapia e terapia ocupacional. Capitulo II, Art 8º. IV. Resolução COFFITO-10 de 3 de julho de 1978.
Mizutani A, Taniguchi K, Miyagawa A, Ikebe H, Yoshitake S, Honda N. The analgesic effect of iontophoresis with magnesium sulfate. Masui 1995;44:1076-9.
Azov SKH, Garazha NN, Glazkova SA, Pendiur OM. Comparative evaluation of the effectiveness of calcium, copper, zinc and iodine ion electrophoresis in treating apical periodontitis. Stomatologia 1981;60:22-4.
Stookey KR, Li YM, Hancock EB, Stookey GK. Effect of zinc upon cell attachment and proliferation on periodontally-diseased root surfaces. J Periodontol 1991;62:445-51.
Dakowicz A, Latosiewicz R. The value of iontophoresis combined with ultrasound in patients with the carpal tunnel syndrome. Rocz Akad Med Bialymst 2005;50:196-8.
Adamian LV, Mynbaev OA, Strugatskii VM. An experimental validation of hyaluronidase electrophoresis for the prevention of postoperative adhesions. Vopr Kurortol Fizioter Lech Fiz Kult 1995;3:18-20.
Stolman LP. Treatment of excess sweating of the palms by iontophoresis. Arch Dermatol 1987;123:893-6.
Nakamura Y, Takahashi K, Shimetani A, Sakagami H, Nishikawa H. Cytotoxicity of direct current with antibacterial agents against host cells in vitro. J Endod 2005;31:755-8.
Demirtas RN, Oner C. The treatment of lateral epicondylitis by iontophoresis of sodium salicylate and sodium diclofenac. Clin Rehabil 1998;12:23-9.
Kahn J. PrincÃpios e prática de eletroterapia. 4ª ed. São Paulo: Santos; 2001. p.119-40.
Bisschop G, Bisschop E. Commandré F. Eletrofisioterapia. São Paulo: Santos; 2001. p.24-34.
DuPont JS Jr. Clinical use of iontophoresis to treat facial pain. Cranio 2004;22:297-303.
Travanti Pharma Inc. IontoPatch Brochure. [citado 2005 nov 1]. DisponÃvel em URL: http://www.iontopatch.com/pdf/IontoPatch_Brochure.pdf.
Leduc BE, Caya J, Tremblay S, Bureau NJ, Dumont M. Treatment of calcifying tendinitis of the shoulder by acetic acid iontophoresis: a double-blind randomized controlled trial. Arch Phys Med Rehabil 2003;84:1523-7.
Perron M, Malouin F. Acetic acid iontophoresis and ultrasound for the treatment of calcifying tendinitis of the shoulder: a randomized control trial. Arch Phys Med Rehabil 1997;78:379-84.
Toro JR, RodrÃguez IG, Espinel JP, Caballero MLG, RodrÃguez F. SÃndrome del canal carpiano crónico idiopático: eficacia del tratamiento de iontoforesis-corticoide frente iontoforesis-placebo (galvanización). Rehabilitación 1997; 31:118-126.
Wang Y, Thakur R, Fan Q, Michniak B. Transdermal iontophoresis: combination strategies to improve transdermal iontophoretic drug delivery. Eur J Pharm Biopharm 2005;60:179-91.
Mitragotri S, Kost J. Low-frequency sonophoresis: a review. Adv Drug Deliv Rev 2004;56:589-601.
Fang JY, Hwang TL, Huang YB, Tsai YH. Transdermal iontophoresis of sodium nonivamide acetate. V. Combined effect of physical enhancement methods. Int J Pharm 2002;235:95-105.
Downloads
Published
Issue
Section
License
Authors are authorized for non-exclusive distribution of the version of the work published in this journal (eg, publishing in an institutional repository or as a book chapter), with acknowledgment of authorship and initial publication in this journal.
