BlueCross BlueShield of Tennessee Medical Policy Manual

Iontophoresis for Medical Indications

DESCRIPTION

Iontophoresis is a method of transdermal local drug delivery using electrical current. A charged, ionic drug is placed on the skin using an electrode of the same charge, allowing direct current to drive the drug into the skin. Iontophoresis may take advantage of sweat ducts, sebaceous glands, hair follicles, and imperfections in the skin to achieve penetration. Alternatively, electrical potential across the skin could alter its permeability, possibly creating potential-dependent pores in lipid bilayer membranes. It has been proposed for numerous uses, including delivering local anesthetic before skin puncture or other painful dermal procedures, local drug delivery for agents such as nonsteroidal anti-inflammatory drugs, or corticosteroids for musculoskeletal inflammatory disorders. In the treatment of musculoskeletal disorders, iontophoresis is often offered in the physical medicine and rehabilitation setting. Iontophoresis has also been investigated for the treatment of hyperhidrosis of the hands and feet.

POLICY

Iontophoresis as a transdermal drug delivery technique for medical indications is considered investigational.

See also: Phonophoresis for Medical Indications

ADDITIONAL INFORMATION

Scientific evidence in the form of published studies in peer-review journals regarding the efficacy of iontophoresis as a transdermal drug delivery technique compared to other methods is lacking

Iontophoresis as a transdermal drug delivery technique for medical indications does not meet the following technology evaluation criteria:

• The technology must improve the net health outcome.

• The technology must be as beneficial as any established alternatives.

SOURCES

Ashburn, M. A., Gauthier, M., Love, G., Basta, S., Gaylord, B., & Kessler, K. (1997). Iontophoretic administration of 2% lidocaine HCL and 1:100,000 epinephrine in humans. Clinical Journal of Pain, 13 (1), 22-26. Abstract retrieved April 24, 2000 from PubMed database.

Ashburn, M. A., Streisand, J., Zhang, J., Love, G., Rowin, M., Niu, S., et al. (1995). The iontophoresis of fentanyl citrate in humans. Anesthesiology, 82 (5), 1146-1153. Abstract retrieved April 24, 2000 from PubMed database.

Banta, C. A. (1994). A prospective, nonrandomized study of iontophoresis, wrist splinting, and antiinflammatory medication in the treatment of early-mild carpal tunnel syndrome. Journal of Occupational Medicine, 36 (2), 166-168.

Bertolucci, L. E. (1982). Introduction of antiinflammatory drugs by iontophoresis: Double blind study. The Journal of Orthopaedic and Sports Physical Therapy, 4, 103-108.

BlueCross BlueShield Association. Medical Policy Reference Manual. (1:2003). Iontophoresis as a technique for drug delivery (8.03.14). Retrieved October 14, 2003 from BlueWeb.

BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2004). Treatment of hyperhidrosis (8.01.19). Retrieved June 29, 2006 from BlueWeb.

Costello, C. T., & Jeske, A. H. (1995). Iontophoresis: Applications in transdermal medication delivery. Physical Therapy, 75 (6), 554-563.

DeCou, J. M., Abrams, R. S., Hammond, J. H., Lowder, L. R., & Gauderer, W. L. (1999). Iontophoresis: A needle-free, electrical system of local anesthesia delivery for pediatric surgical office procedures. Journal of Pediatric Surgery, 34 (6), 946-949.

Dowd, N. P., Day, F., Timon, D., Cunningham, A. J., & Brown, L. (1999). Iontophoretic vincristine in the treatment of postherpetic neura a double-blind, randomized, controlled trial. Journal of Pain Symptom Management, 17 (3), 175-180. Abstract retrieved April 24, 2000 from PubMed database.

Gudeman, S. D., Eiscle, S. A. Heidt, R. S. Jr., Colosimo, A. J., & Stroupe, A. L. (1997). Treatment of plantar fasciitis by iontophoresis of 0.4% dexamethasone. A randomized, double-blind, placebo-controlled study. American Journal of Sports Medicine, 25, 312-316. Abstract retrieved October 15, 2003 from PubMed database.

Health Technology Assessment Information Service. Custom Hotline Response. (2006, April). Iontophoresis for drug delivery in physical medicine & rehabilitation settings. Retrieved June 29, 2006 from ECRI HTAIS.

Li, L. C., Scudds, R. A., Heck. C. S., & Harth, M. The efficacy of dexamethasone iontophoresis for the treatment of rheumatoid arthritic knees: A pilot study. Arthritis Care Research, 9 (2), 126-132. Abstract retrieved April 24, 2000 from PubMed database.

Pellecchia, G. L., Hamel, H., & Behnke, P. (1994). Treatment of infrapatellar tendinitis: A combination of modalities and transverse friction massage versus iontophoresis. Journal of Sport Rehabilitation, 3, 135-145.

Sadler, P. J., Thompson, H. M., Maslowski, P., Liddle, A., & Rowbotham, D. J. (1999). Iontophoretically applied lidocaine reduces pain on propofol injection. British Journal of Anesthesia, 82 (3), 432-434.

Saggini, R., Zoppi, M., Vecchiet, F., Gatteschi, L. Obletter, G., & Giamberardino, M. A. (1996). Comparison of electromotive drug administration with Ketorolac or with placebo in patients with pain from rheumatic disease: A double-masked study. Clinical Therapeutics, 18 (6), 1169-1174.

Schiffman, E. L., Braun, B. L., & Lindgren, B. R. (1996). Temporomandibular joint iontophoresis: A double-blind randomized clinical trial. Journal of Orofacial Pain, 10 (2), 157-165. Abstract retrieved October 15, 2003 from PubMed database.

The Technology Evaluation Center. (2003, June). Iontophoresis for medical indications, (Vol. 18, No. 8). Retrieved June 29, 2006 from http://www.bcbs.com/tec/vol18/18_03.html.

U. S. Food and Drug Administration. (2004, August). Center for Devices and Radiological Health. Device listing database. Retrieved June 29, 2006 from http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/search/search.cfm?db=LST&ID=327828.

Zempsky, W. T., Anand, K. J. S., Sullivan, K. M., Fraser, D., & Cucina, K. (1998). Lidocaine iontophoresis for topical anesthesia before intravenous line placement in children. The Journal of Pediatrics, 132 (6), 1061-1063.

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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