Safety and efficacy of intranasally administered medications in the emergency department and prehospital settings

Corrigan, Megan; Wilson, Suprat Saely; Hampton, Jeremy P.

doi:10.2146/ajhp140630

Cited by 79 publications

(53 citation statements)

References 83 publications

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“…INF is an opioid with an almost immediate analgesic effect if applied intranasally because of no first-pass metabolism 9. Its analgesic power is similar to intravenous morphine and its use is safe and effective in children with no reported adverse events 10–12.…”

Section: Introductionmentioning

confidence: 99%

Combined nitrous oxide 70% with intranasal fentanyl for procedural analgosedation in children: a prospective, randomised, double-blind, placebo-controlled trial

Staubli

Landolt

2019

Emerg Med J

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ObjectiveNitrous oxide 70% (N2O 70%) is an excellent medication for procedural analgosedation (PAS), yet the limit of its analgesic power remains uncertain; therefore, a combination with intranasal fentanyl (INF) was suggested. However, this combination seems to result in a higher rate of vomiting and deeper sedation. This study aimed at assessing the analgesic efficacy, sedation depth and rate of adverse events of PAS with N2O 70% with and without INF.MethodsPatients aged 2–16 years who qualified for PAS with N2O 70% were randomly assigned to receive either INF or placebo prior to N2O inhalation in this randomised, double-blind study, which was performed in a tertiary children’s hospital ED between September 2015 and October 2017. Behaviour during the procedure was evaluated using the Face, Leg, Activity, Cry and Consolability (FLACC) scale and the Modified Behavioural Pain Scale (MBPS); analgesic efficacy was assessed with a self-reported pain scale. Sedation depth using the validated University of Michigan Sedation Scale and adverse events in the ED and during the following 12 hours were documented.ResultsA total of 402 patients were included; 3 did not tolerate N2O and therefore had to be excluded. Overall, 399 patients were analysed, of whom 201 (50.4%) received INF. No significant group differences with regard to FLACC scale score, self-reported pain, MBPS score and sedation depth were found. In addition, the two groups did not differ with regard to all types of adverse events.ConclusionCombining N2O 70% with INF resulted in no differences with regard to FLACC scale score, self-reported pain, MBPS score, patient and parental satisfaction rate, sedation depth, and adverse events.Trial registration numberNCT02533908

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Section: Introductionmentioning

confidence: 99%

Combined nitrous oxide 70% with intranasal fentanyl for procedural analgosedation in children: a prospective, randomised, double-blind, placebo-controlled trial

Staubli

Landolt

2019

Emerg Med J

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“…Here are 4 important concepts to consider with intranasal administration 7,8 : minimize barriers to absorption and ensure that the nasal mucosa is available and free of secretions and blood, minimize the volume and maximize drug concentration to stay below the 1-mL volume limitation, take advantage of maximal absorption by using both nostrils, and use a delivery system that maximizes drug dispersion.…”

Section: Why Intranasal?mentioning

confidence: 99%

Does the Intranasal Route Pass the Sniff Test?

Joshi

Hayes

Mason

et al. 2017

Annals of Emergency Medicine

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“…The nasal cavity is an ideal site for drug delivery, particularly for medications requiring a rapid onset of action, because of the degree of vascularization and tissue permeability 18 . Intranasal (IN) administration has been explored for a wide variety of drugs, including naloxone, nalmefene, fentanyl, hydromorphone, midazolam, glucagon, and haloperidol 19‐26 . For example, IN glucagon for hypoglycemia treatment and midazolam for seizure termination are used when an immediate pharmacologic intervention is required 23,26 .…”

Section: Introductionmentioning

confidence: 99%

Intranasal epinephrine in dogs: Pharmacokinetic and heart rate effects

Dretchen

Mesa

Robben³

et al. 2020

Pharmacology Res & Perspec

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Epinephrine is the standard of care for the treatment of severe allergy and anaphylaxis. Epinephrine is most often administered through the intramuscular (IM) route via autoinjector. The current study aimed to evaluate an alternative method of epinephrine treatment through intranasal (IN) delivery in dogs. The pharmacokinetic (PK) parameters of maximum plasma concentration (Cmax), time to reach maximum plasma concentration (Tmax), and area under the plasma concentration‐time curve from 0 to 90 minutes (AUC0–90) were observed after IN epinephrine (2, 3, 4, 5, 10, and 20 mg) and IM epinephrine via autoinjector (0.15 and 0.3 mg) for 90 minutes. Heart rate effects were measured after IN (2 and 5 mg) and IM (0.15 and 0.3 mg) epinephrine administration. IN epinephrine (5 mg) demonstrated significantly greater plasma epinephrine concentration at 1 minute as compared with IM epinephrine (0.3 mg) (1.68 ± 0.65 ng/mL vs 0.21 ± 0.08 ng/mL, P = .03). There were no significant differences in Cmax, Tmax, and AUC0–90 between 2‐mg IN and 0.15‐mg IM epinephrine or between 5‐mg IN and 0.3‐mg IM epinephrine. IN epinephrine reduced heart rate increases, as compared to IM epinephrine. IN and IM epinephrine were both well‐tolerated. Overall, IN epinephrine demonstrated advantages over IM epinephrine, including the rapid increase in plasma epinephrine and lack of increased heart rate over time.

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Safety and efficacy of intranasally administered medications in the emergency department and prehospital settings

Cited by 79 publications

References 83 publications

Combined nitrous oxide 70% with intranasal fentanyl for procedural analgosedation in children: a prospective, randomised, double-blind, placebo-controlled trial

Combined nitrous oxide 70% with intranasal fentanyl for procedural analgosedation in children: a prospective, randomised, double-blind, placebo-controlled trial

Does the Intranasal Route Pass the Sniff Test?

Intranasal epinephrine in dogs: Pharmacokinetic and heart rate effects

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