Intranasal drug delivery: An efficient and non-invasive route for systemic administration

Grassin-Delyle, Stanislas; Buenestado, Amparo; Naline, Emmanuel; Faisy, Christophe; Blouquit-Laye, Sabine; Couderc, Louis‐Jean; Guen, Morgan Le; Fischler, Marc; Devillier, Philippe

doi:10.1016/j.pharmthera.2012.03.003

Cited by 332 publications

(209 citation statements)

References 154 publications

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“…Because drugs can be absorbed into the systemic circulation through the nasal mucosa, this route may also be used in patients with buccal problems, including mucositis or dry mouth. 8 There are 2 approved nasal fentanyl products. Intranasal fentanyl (INFS) comprises an aqueous-buffered solution containing fentanyl citrate equivalent to .5, 1, or 2 mg/mL of fentanyl base.…”

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confidence: 99%

“…Intranasal fentanyl (INFS) comprises an aqueous-buffered solution containing fentanyl citrate equivalent to .5, 1, or 2 mg/mL of fentanyl base. 7,8 The product provides fentanyl doses of 50, 100, and 200 mg. Fentanyl pectin nasal spray (FPNS) is an aqueous solution that is based on a delivery system to provide in situ gelling of the formulation, which reduces the potential for drip, modulating fentanyl release compared to a simple solution. 12,28 Two strengths are available containing either 100 or 400 mg fentanyl citrate equivalent.…”

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confidence: 99%

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Intranasal Fentanyl Versus Fentanyl Pectin Nasal Spray for the Management of Breakthrough Cancer Pain in Doses Proportional to Basal Opioid Regimen

Mercadante

Prestia

Adile

et al. 2014

The Journal of Pain

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The aim of this randomized, crossover, comparison study was to assess the analgesic and adverse effects of 2 nasal preparations, intranasal fentanyl (INFS) and fentanyl pectin nasal spray (FPNS), for breakthrough pain, given in doses proportional to opioid basal regimen. Each patient randomly received INFS or FPNS in doses proportional to opioid dosages used for background analgesia for 2 pairs of episodes. For each episode of breakthrough pain, pain intensity and adverse effects intensity were recorded just before starting the INFS or FPNS (T0) and 5 minutes (T5), 10 minutes (T10), and 20 minutes (T20) after the administration of the nasal drugs. Sixty-nine patients were studied. The mean age was 63.4 years, and 37 patients were males. For the present analysis, 188 episodes were considered. A statistical decrease in pain intensity was observed with both nasal drugs after 5, 10, and 20 minutes. A decrease in pain intensity of >33% was observed in 16, 102, and 159 treated episodes at T5, T10, and T20, respectively. Adverse effects were of mild nature in most cases or were preexistent because of basal opioid therapy. No differences were found in summed pain intensity difference 20 minutes after dosing. Most of patients did not find substantial preferences. INFS and FPNS were effective and well-tolerated treatments for breakthrough pain management. Both delivery systems, in doses proportional to the basal opioid regimen, provided significant analgesia within 10 minutes, without producing relevant adverse effects.Perspective: This article showed that INFS and FPNS in doses proportional to basal opioid regimen are equally safe and effective for the management of breakthrough pain in cancer patients. These data provide new insights on the use of nasal preparations of fentanyl.

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confidence: 99%

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confidence: 99%

Intranasal Fentanyl Versus Fentanyl Pectin Nasal Spray for the Management of Breakthrough Cancer Pain in Doses Proportional to Basal Opioid Regimen

Mercadante

Prestia

Adile

et al. 2014

The Journal of Pain

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“…Fentanyl has high lipophilicity, which allows it to pass the nasal respiratory epithelium by the transcellular route and rapidly achieve maximum plasma concentrations within 7 to 15 minutes, as well as readily cross from the plasma to the CNS through the blood-brain barrier. [12][13][14] The time to onset of clinically meaningful analgesia with IN fentanyl administration has been reported to be between 5 and 15 minutes, the rapidity of which could be attributed in part to the direct absorption of medication through the nose-brain pathway. 9,[15][16][17][18] The use of fentanyl instead of morphine could also address the possibility that morphine might lower the systemic vascular resistance, and potentially worsen the shunting of deoxygenated blood from the right to left heart.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Tetralogy of Fallot Hypoxic Spell With Intranasal Fentanyl

et al. 2014

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We present the case of a 3-month-old girl who had unrepaired Tetralogy of Fallot who presented to the emergency department with an acute hypoxic episode. The patient was hyperpneic and cyanotic, with an initial oxygen saturation of 56%. She did not respond to knee-to-chest positioning. A single dose of intranasal fentanyl was administered with subsequent resolution of her symptoms and improvement of her oxygen saturation to 78% within 10 minutes. To our knowledge, this is the first report of the successful treatment of a hypoxic episode of Tetralogy of Fallot using intranasal fentanyl. Dr Tsze conceptualized the case report, wrote the manuscript, and critically reviewed and revised the manuscript; Dr Vitberg assisted with data acquisition and critically reviewed and revised the manuscript; Dr Berezow provided substantial intellectual input and critically reviewed and revised the manuscript; Dr Starc provided substantial intellectual input and critically reviewed and revised the manuscript; Dr Dayan provided substantial intellectual input and critically reviewed and revised the manuscript; and all authors approved the final manuscript as submitted.www.pediatrics.org/cgi

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“…Differing formulations for IN fentanyl have been developed [199], but the overall efficacy results are similar: IN fentanyl data are incomplete but the approach has promise for a variety of patient types [200][201][202]. It appears possible that, while the analgesic efficacy may not match that of IV morphine, the ease of administration may render IN fentanyl (one commonly used dose is 1.5 mcg/kg via atomizer) a viable option in some situations [203].…”

Section: Fentanylmentioning

confidence: 99%

Management of Pain in the Emergency Department

Thomas

2013

ISRN Emergency Medicine

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Since pain is a primary impetus for patient presentation to the Emergency Department (ED), its treatment should be a priority for acute care providers. Historically, the ED has been marked by shortcomings in both the evaluation and amelioration of pain. Over the past decade, improvements in the science of pain assessment and management have combined to facilitate care improvements in the ED. The purpose of this review is to address selected topics within the realm of ED pain management. Commencing with general principles and definitions, the review continues with an assessment of areas of controversy and advancing knowledge in acute pain care. Some barriers to optimal pain care are discussed, and potential mechanisms to overcome these barriers are offered. While the review is not intended as a resource for specific pain conditions or drug information, selected agents and approaches are mentioned with respect to evolving evidence and areas for future research.

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Intranasal drug delivery: An efficient and non-invasive route for systemic administration

Cited by 332 publications

References 154 publications

Intranasal Fentanyl Versus Fentanyl Pectin Nasal Spray for the Management of Breakthrough Cancer Pain in Doses Proportional to Basal Opioid Regimen

Intranasal Fentanyl Versus Fentanyl Pectin Nasal Spray for the Management of Breakthrough Cancer Pain in Doses Proportional to Basal Opioid Regimen

Treatment of Tetralogy of Fallot Hypoxic Spell With Intranasal Fentanyl

Management of Pain in the Emergency Department

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