Intranasal medication

Patients who may benefit from allergen immunotherapy include those who do not tolerate traditional drug therapy (e.g., nosebleeds with intranasal steroids or sedation with antihistamines), suffer from severe symptoms, have comorbid conditions (e.g., asthma or sinusitis), fail drug therapy, or prefer not to take long-term medication. 

Pharmacotherapy has an important role in managing AR symptoms (Table 59-2). Intranasal corticosteroids, systemic and topical antihistamines and decongestants, mast cell stabilizers, and immunotherapy all are beneficial in treating symptoms of AR.9 Antihistamines and intranasal corticosteroids are considered first-line therapy for AR, whereas decongestants, mast cell stabilizers, leukotriene modifiers, and systemic corticosteroids are secondary treatment options10-12 (Fig. 59-2). Whenever exposure to allergens can be predicted (e.g., SAR or visiting homes with a pet), medications should be used pro-phylactically to maximize effectiveness.11... 

S. E. Chang and Y. W. Chien. Intranasal drug administration for systemic medication. Pharm Int 5 287-288 (1984). 

Y. W. Chien and S. F. Chang. Intranasal drug delivery for systemic medications. Crit Rev Ther Drug Carrier Syst 4 67-194 (1987). 

Desmopressin (the synthetic analog of vasopressin) acts by increasing water retention and urine concentration in the distal tubules of the kidney. This drug is administered intranasally (20-40 pg or one to two sprays) using a unit-dose, spray pump delivery system. The duration of action is 10 to 12 hours. The medication is expensive. 

In case of an obstruction of the nasal airways, the swelling should first be reduced and then the patient should apply the anti-inflammatory medication to ensure its necessary distribution over the complete mucosa. Antihistamines in addition to oral therapy may also be applied locally, intranasally or conjunctivally. The combination of all three substance groups (H, antihistamines, topic glucocorticoids and antileukotrienes) as a pretreatment as well as a symptomatic treatment during immunotherapy increases the chances of success of hyposensitization in our experience [unpubl. data]. 

Like amphetamine and cocaine, abuse of MPH [Ritalin] can lead to marked tolerance and severe psychologic dependence. The pattern of abuse is characterized by escalation in dose, binge use followed by severe depression, and an overpowering desire to continue to the use of the drug despite negative medical and social consequences. The abuser may alter the mode of administration from oral use to intranasal or intravenous use to intensify the effects of the drug. (p. 35)... 

Proctor, D. F. (1985), Nasal Physiology in intranasal drug administrations, in Chien, Y. W., Ed., Transnasal Systemic Medications, Elsevier, Amsterdam, pp. 101-106. 

Stadol, N.S. Physicians Desk Reference, 54th Ed. Medical Economics Company Montvale NJ, 2000 853-835. Hussain, A.A. Intranasal drug delivery. Adv. Drug Delivery Rev. 1998, 29, 39 9. 

Sandow, J. Petri, W. Intranasal administration of peptides biological activity and therapeutic efficacy. In Transnasal Systemic Medications Chien, Y.W., Ed. Elsevier Amsterdam, 1985 183-199. 

Jackson LA, Holmes SJ, Mendelman PM, Huggins L, Cho I, Rhorer J. Safety of a trivalent live attenuated intranasal influenza vaccine, FluMist, administered in addition to parenteral trivalent inactivated influenza vaccine to seniors with chronic medical conditions. Vaccine 1999 17(15-16) 1905-9. 

In the treatment of nasal symptoms the patient adjusts the dose so that, perhaps, the theoretical bases of droplet and particle retention are less vital. Although formulation of the nasal drops, or sprays from plastic squeeze-bottles must obviously influence the efficiency of medication, little work has in the past been carried out relating formulation to the effect of intranasal medicines. Microsphere delivery systems have received some attention, however, with special interest being directed to bioadhesive microspheres. 

Administration Intranasal Clear nasal passages before use insert spray up into nostril, pointing toward nasal passages away from nasal septum spray into nostril while holding other nostril closed and concurrently inspire through nose to permit medication as high into nasal passages as possible. 

The availability of new routes of administration have led to increased utility and decreased opioid adverse drug reaction risk. Epidural and intrathecal administration through spinal catheters produces adequate regional analgesia at relatively low total doses compared with intravenous or oral routes. As such, spinal administration can thus minimize somnolence, nausea, vomiting, and respiratory depression associated with these medications. Other alternative routes include intranasal administration of butorphanol, and rectal and transdermal administration of fentanyl [28]. Availability of such options provides not only a decreased risk of adverse reactions, but also more comfortable measures for patients who would otherwise require continued intravenous administration, or for those who are unable to receive oral medication [28,29]. 

Medications. Medications used for treatment should be explained to the patient. Instruction of how to correctly use intranasal corticosteroids should be given [145]. Intranasal steroids provide better control when used regularly than on an as needed basis. Such explanations increase compliance. The mode of action of antihistamines and nasal decongestants on nasal symptoms should be clarified. The side-effects and safety of long-term use of the newer antihistamines and intranasal steroids should be explained. 

Logemann CD, Rankin LM. Newer intranasal migraine medications. Am... 

For seasonal allergic rhinitis, an intranasal antihistamine, aze-lastine, is available. Azelastine has been used successfully in patients who did not respond to loratadine. Using the nasal route offers an alternative to switching to another oral antihistamine. Patient satisfaction has been varied because while the product produces rapid symptom relief, patients complain of drying effects, headache, and diminished effectiveness over time. Patients should be warned of the medication s potential to produce drowsiness, as its systemic availability is approximately 40%. " ... 

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