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INTRODUCTION

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Drugs that may be administered by iontophoresis and phonophoresis are listed here. Administration of these agents by these techniques is largely empirical. The use of these substances in the conditions listed is based primarily on clinical observation and anecdotal reports in the literature. Likewise, the preparation strengths given here are merely suggestions based on currently available information.

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Drug Principal Indication(s) Treatment Rationale Iontophoresis Phonophoresis

Acetic acid

Calcific tendinitis

Acetate is believed to increase solubility of calcium deposits in tendons and other soft tissues

2%–5% aqueous solution from negative pole

Calcium chloride

Skeletal muscle spasms

Calcium stabilizes excitable membranes; appears to decrease excitability threshold in peripheral nerves and skeletal muscle

2% aqueous solution from positive pole

Dexamethasone

Inflammation

Synthetic steroidal anti-inflammatory agent (see Chapter 29)

4 mg/mL in aqueous solution from negative pole

0.4% ointment

Hydrocortisone

Inflammation

Anti-inflammatory steroid (see Chapter 29)

0.5% ointment from positive pole

0.5%–1.0% ointment

Hyaluronidase

Local edema (subacute and chronic stage)

Appears to increase permeability in connective tissue by hydrolyzing hyaluronic acid, thus decreasing encapsulation and allowing disbursement of local edema

Reconstitute with 0.9% sodium chloride to provide a 150 mcg/ml solution from positive pole

Iodine

Adhesive capsulitis and other soft-tissue adhesions; microbial infections

Iodine is a broad-spectrum antibiotic, hence its use in infections, etc.; the sclerolytic actions of iodine are not fully understood

5%–10% solution or ointment from negative pole

10% ointment

Lidocaine

Soft-tissue pain and inflammation (e.g., bursitis, tenosynovitis)

Local anesthetic effects (see Chapter 12)

4%–5% solution or ointment from positive pole

5% ointment

Magnesium sulfate

Skeletal muscle spasms; myositis

Muscle relaxant effect may be caused by decreased excitability of the skeletal muscle membrane and decreased transmission at the neuromuscular junction

2% aqueous solution or ointment from positive pole

2% ointment

Salicylates

Muscle and joint pain in acute and chronic conditions (e.g., overuse injuries, rheumatoid arthritis)

Aspirinlike drugs with analgesic and anti-inflammatory effects (see Chapter 15)

10% trolamine salicylate ointment or 2%–3% sodium salicylate solution from negative pole

10% trolamine salicylate ointment or 3% sodium salicylate ointment

Tolazoline hydrochloride

Indolent cutaneous ulcers

Increases local blood flow and tissue healing by inhibiting vascular smooth muscle contraction

2% aqueous solution or ointment from positive pole

Zinc oxide

Skin ulcers; other dermatologic disorders

Zinc acts as a general antiseptic; may increase tissue healing

20% ointment from positive pole

20% ointment

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