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ONTO
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7/17/2019 Ionto Color
http://slidepdf.com/reader/full/ionto-color 1/17
IONTOPHORESISReading: Cameron pgs 272-276
• Use of Direct Current to facilitate delivery of
ions into the skin for therapeutic purposes.
• Mechanism of delivery:
“ LIKE CHARGES REPEL”
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Contemporary Use• In PT: primarily for treating localized
inflammatory conditions in superficial
tissues
– Use corticosteroids,
(usually dexamethasone)
• Multiple uses of other non-steroidal ions
both within & outside PT
• Ex: Dentistry, Dermatology, Emergency
Dept, Ophthalmology
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Dexamethasone: mostcommonly used for Ionto• Dexamethasone Sodium Phosphate
• 0.4% aqueous solution
• 0.4% = 0.004 g/ml = 4 mg/ml
– Dissolves & ionizes into Dex-P & Na
• corticosteroid for anti-inflammatory
effects; polarity is (-)
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Additional Ions Used in PT(FYI)
• Acetic Acid (-) dissolve Ca deposits
• Calcium Chloride (+) ms. relaxant
• Hyaluronidase (+) disperse edema; not acute
• Iodine (-) softens adhesions & scar tissue• Magnesium Sulfate (+) ms. relaxant
• Sodium Salicylate (-) ms. & joint pain
• Lidocaine (+) local anesthetic
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Depth of ion penetration• Believed to occur primarily thru pores
(sweat & oil) & hair fol licles
• Passive diffusion and local circulation
are required to transport the drug
deeper, to the cells of the target tissue
• Research – effect is often inferred based
on clinical effectiveness (pain, ROM, MMT,
function)
• max depth of ion penetration is largelyunknown in humans (8-10mm in mammals)
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Ionto: Advantages over injection
• non-invasive; less risk of infection
• less pain & anxiety
• less drug into systemic circulation;
decreased side effects• Less risk of local collagen
catabolism*
* assuming use of corticosteroid
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Ionto: Advantages over drug PO
• avoids “ first-pass” elimination by
liver.• less drug into systemic circulation;
decreased side effects.
• potentially greater concentration of
drug in the target area
• supervised; maximizes compliance.
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Ionto: Disadvantages• risk skin irritation or burn
• depth of penetration known to vary b/c of
variation of current density, skin
impedence, skin/fat thickness, and
ionization/pH
• greater risk of local collagen catabolism
than oral administration*
• Action of drug – localizedimmunosuppression*
* assuming use of corticosteroid
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Contraindications & Precautions• Typical E-stim contraindications & precautions
apply
• Pt. allergic to drug/substance being used?• No thermal modalities immediately before or
after. Why??
• No conductive gel before Ionto. Why??• Diabetes is a precaution due to decreased
peripheral sensation, and combination of
localized immunosuppression caused by
corticosteroid and risk of skin damage byDirect Current.
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Treatment Parameters• Current: DC (can cause elctrochemical changes)
• Amplitude: 0.08 to 4.0 mA is the range
• Dosage Formula: amplitude X time = mA·min
• Dosage: 40 to 80 mA-min is the range
• POLARITY– use the same polarity as the drug ion
• Rx frequency: every other day at the most• steroid effects can be delayed & last several days
• allows time for skin to recover
• minimize risk of side effects• Rx number: 4 - 7 max
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Equipment & Supplies Needed• Drug ion in aqueous solution
• Absorbent & buffered electrode
• Iontophoresis delivery systems (equipment)
– DC stimulator (>1.0 mA; Rx time <1 hr)
– Patch products: (<0.25 mA, Rx time 4-6 hrs)Iontopatch, ActionPatch, etc..
– Hybresis by EMPI (high, then low mA, Rxtime > 1hr)
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DC Stimulator: Dupel by EMPI
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Skin Safety with use of DC stimulator• Amplitude: pt feels a tolerable itching or stinging.
• Erethema under the electrodes is a normal reaction
due heat build-up & chemical build-up• Skin pigmentation: skin response harder to judge.
OK NOT OK NOT OK
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Patch: Iontopatch
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Patch: Action-Patch by EMPI
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Hybrid System: HYBRESIS by
EMPI
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Effectiveness Factors• Dosage: mA-min
– Do different combinations of amplitude & time
provide equivalent amounts & depth of iontransfer?
• Preparation of skin
• must be clean; no competing ions.
• Depth of target tissue
• skin thickness, fat layer, overlying tissues
• Electrode Contact