Therapeutic
Intranasal Drug DeliveryWhy you should consider intranasal drug administration as another option for delivering medications to patients:
Acute seizures,
narcotic overdose, severe hypoglycemia, procedural sedation, and acute and chronic pain control
are all complex medical problems requiring multiple approaches for
effective management. Intranasal (IN) drug delivery is emerging as a
low-tech, inexpensive and non-invasive first line method for managing
these and other medical problems.
Nasal medication delivery takes a middle path between slow onset
oral medications and invasive, highly skilled delivery of intravenous
medications. Medication deposited on the highly vascular nasal mucosa
may be rapidly absorbed into the blood stream and cerebral spinal fluid
(CSF), achieving therapeutic drug levels more quickly and predictably
than oral medications while avoiding needles. This results in therapeutic drug levels and
effective treatment of seizures, pain, anxiety, hypoglycemia, opiate
overdose, epistaxis (bloody noses), etc without the need to give a shot
or a pill. Because intra-nasal medication delivery is effective using
generic medications, it is quite inexpensive, an advantage in this era
of increasingly expensive medical technology. This web site offers
health care and consumers information about nasal drug therapy: medical research, expert testimonial opinion
and protocol suggestions. M
Testimonial regarding importance of intranasal medication delivery
as another therapeutic option:
Ray Fowler, MD; Professor of Emergency Medicine, Chief of
EMS, Parkland Memorial Hospital, Dallas Texas
January 14, 2010
Dear
Tim,
I am
offering this little note to share with you some thoughts regarding the
importance of mucosal administration in the care of our patients. It is
clear to us in the fields of emergency medicine and EMS medicine that we
have had a long neglected opportunity for care. You have brought this
advance to the forefront. You saw clearly that through a novel yet
simple idea, we could garner a new advantage that had long been missing
in clinical care. Because of your insight, we can now approach many of
the long‐dealt‐with dilemmas in emergency care that before often eluded
us, indeed caused us to offer in many cases less than optimal care.
One
important example is in the treatment of seizures. Those of us who have
dealt with pediatric patients suffering from convulsions for example, in
the absence of intravenous access, have been left with virtually no
other alternative than the per rectum administration of diazepam to halt
the seizure. You gathered the budding information in the literature and
quickly adapted an invention that could simply, safely treat this
difficult problem in a much more proper, much less toxic manner. This
has been a great advance in the history of medicine.
Another critical area, the dilemma of “excited delirium,” presents a
hazard to patient and responder alike. These patients must often be
sedated to provide safety in therapy and management. The intranasal
route of administration presents a fast alternative that is much less
hazardous for the responding emergency provider as regards the potential
for infectious disease contamination from the patient, especially in the
difficult problem of the spread of viruses such as hepatitis C and HIV
through needle‐stick exposure.
Finally, we all understand how important the prompt treatment of severe
pain is to our patients. We now have the capability of prompt
administration of fentanyl via the intranasal route and thousands of
patients will no longer suffer as a result of this important medical
advance.
I
would close by thanking you for your contributions to medicine, Tim. You
have seen clearly where others did not. Because of your persistence and
your great loving heart, patients everywhere – who will never know you –
are being treated promptly and humanely, for the benefit of all
concerned.
Thank
you for your service and dedication.
With
kind regards, I am
Respectfully,
Raymond L. Fowler, MD, FACEP
Professor of Emergency Medicine
Chief
of EMS Operations
Southwestern Medical Center at Dallas
Attending Emergency Medicine Faculty
Parkland Memorial Hospital