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It was taken off the market, he says, because to make it suitable
for injection, it was dissolved in an excipient called cremophor
EL. The excipient caused severe allergic reactions in a small per-
centage of patients. That happened to be just when the boom in
outpatient surgery was beginning, and the withdrawal created a
huge need for another fast-onset, short-duration anesthetic — a
vacuum that was quickly filled by propofol.
Althesin was gone, but not forgotten. Fast forward to 2010,
when Dr. Goodchild's wife, neuroscientist and anesthesiologist
Juliet Serrao, PhD, recalling the sadness senior anesthesia
providers had expressed over the loss of Althesin, suggested to
her husband that a reformulation with modern excipients might
solve the allergy problem.
"She's the primary inventor (of Phaxan)," says Dr. Goodchild.
"She said, look, propofol is getting really bad press, it's outlived its
usefulness. You should look at Althesin and try other ways to dis-
solve it." It wasn't long before a new formulation was born, one
that uses a water-based excipient, sulfobutyl ether-beta-cyclodex-
trin, which, says Dr. Goodchild, has long been recognized as safe
by the FDA.
Dr. Goodchild says not only won't Phaxan impair cognitive abili-
ty, it may actually help protect it. "Because it's an allopreg-
nanolone analogue," says Dr. Goodchild, "chances are, Phaxan
will be able to replace allopregnanolone levels that are falling
(during surgery) and will protect the aging brain from the inflam-
mation that the surgical onslaught causes." Dr. Goodchild says
Phaxan is still years away from hitting the market.
— Jim Burger
SURGEONS'
Lounge
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