Therapeutic
Intranasal Drug DeliveryMiscellaneous intranasal medications
The number of potential applications for intranasal medications is enormous. Potential uses that may enhance or provide alternative treatment modalities include headache therapy,[1-15] antinausea medication delivery in patients intolerant of oral medications,[16-19] chronic pain therapy,[20-25] insulin therapy (avoid multiple daily shots),[26] vaccine administration (enhance immune response by delivery via a more natural exposure route),[27-29] antipsychotic medications (reduce chance or injury to patient and provider) and even the delivery of medications and drug antidotes such as hydroxocobalamin (antidote to cyanide poisoning)[11, 30, 31].
Some of these concepts are fully developed and commercially available pharmaceutical products are already available on the market such as intranasal dihydroergotamine for headaches[13] and nasal vaccines for influenza.[27-29] Other concepts, such as intranasal hydroxocobalamin are purely conjecture and may or may not be viable concepts.
The area of intranasal medication delivery provides a huge opportunity for research – both for specifically developed pharmaceutical drugs designed for intranasal treatment, as well as for investigating off label uses of commonly available generic medications.Bibliography (click here for abstracts)
1. Mills, T.M. and J.A. Scoggin, Intranasal lidocaine for migraine and cluster headaches. Ann Pharmacother, 1997. 31(7-8): p. 914-5.
2. Maizels, M., et al., Intranasal lidocaine for treatment of migraine: a randomized, double-blind, controlled trial [see comments]. Jama, 1996. 276(4): p. 319-21.
3. Maizels, M. and A.M. Geiger, Intranasal lidocaine for migraine: a randomized trial and open-label follow-up. Headache, 1999. 39(8): p. 543-51.
4. Costa, A., et al., The effect of intranasal cocaine and lidocaine on nitroglycerin-induced attacks in cluster headache. Cephalalgia, 2000. 20(2): p. 85-91.
5. Buckley, R., T. McCurry, and J. Gera, Intranasal lidocaine for migraine using a metered-dose spray. Headache, 2000. 40(6): p. 498.
6. Maizels, M., et al., Intranasal lidocaine for treatment of migraine: a randomized, double-blind, controlled trial. Jama, 1996. 276(4): p. 319-21.
7. Robbins, L., Intranasal lidocaine for cluster headache. Headache, 1995. 35(2): p. 83-4.
8. Quadir, M., H. Zia, and T.E. Needham, Development and evaluation of nasal formulations of ketorolac. Drug Deliv, 2000. 7(4): p. 223-9.
9. Markley, H.G., Topical agents in the treatment of cluster headache. Curr Pain Headache Rep, 2003. 7(2): p. 139-43.
10. Kudrow, L., D.B. Kudrow, and J.H. Sandweiss, Rapid and sustained relief of migraine attacks with intranasal lidocaine: preliminary findings. Headache, 1995. 35(2): p. 79-82.
11. van der Kuy, P.H., et al., Hydroxocobalamin, a nitric oxide scavenger, in the prophylaxis of migraine: an open, pilot study. Cephalalgia, 2002. 22(7): p. 513-9.
12. Rapoport, A. and P. Winner, Nasal delivery of antimigraine drugs: clinical rationale and evidence base. Headache, 2006. 46 Suppl 4: p. S192-201.
13. Weintraub, J., Repetitive dihydroergotamine nasal spray for treatment of refractory headaches: an open-label pilot study. Curr Med Res Opin, 2006. 22(10): p. 2031-6.
14. Rapoport, A.M., et al., Intranasal medications for the treatment of migraine and cluster headache. CNS Drugs, 2004. 18(10): p. 671-85.
15. Logemann, C.D. and L.M. Rankin, Newer intranasal migraine medications. Am Fam Physician, 2000. 61(1): p. 180-6.
16. Ormrod, D. and K.L. Goa, Intranasal metoclopramide. Drugs, 1999. 58(2): p. 315-22; discussion 323-4.
17. Wagner, B.K., et al., A double-blind, placebo-controlled evaluation of intranasal metoclopramide in the prevention of postoperative nausea and vomiting. Pharmacotherapy, 1996. 16(6): p. 1063-9.
18. Tomirotti, M., et al., Efficacy and tolerability of nasally administered compared to parenterally administered metoclopramide in the symptomatic treatment of chemotherapy-induced emesis in cancer outpatients. A controlled clinical study. Support Care Cancer, 1994. 2(6): p. 389-92.
19. Cho, E., H. Gwak, and I. Chun, Formulation and evaluation of ondansetron nasal delivery systems. Int J Pharm, 2008. 349(1-2): p. 101-7.
20. Flood, P. and D. Daniel, Intranasal nicotine for postoperative pain treatment. Anesthesiology, 2004. 101(6): p. 1417-21.
21. Zeppetella, G., An assessment of the safety, eff icacy, and acceptability of intranasal fentanyl citrate in the management of cancer-related breakthrough pain. A pilot study. J Pain Symptom Manage, 2000. 20(4): p. 253-8.
22. Cleary, J.F., Pharmacokinetic and pharmacodynamic issues in the treatment of breakthrough pain. Semin Oncol, 1997. 24(5 Suppl 16): p. S16-13-9.
23. Goudas, L.C., et al., Efficacy and safety of intranasal ketamine for the management of breakthrough pain in chronic pain. A randomized, double-blind, placebo-controlled, cross-over trial. American Society of Clinical Oncology Meeting, 2002. Abstract No: 450.
24. Bell, Rf, and Kalso, Is intranasal ketamine an appropriate treatment for chronic non-cancer breakthrough pain? Pain, 2004. 108(1-2): p. 1-2.
25. Carr, D.B., et al., Safety and efficacy of intranasal ketamine for the treatment of breakthrough pain in patients with chronic pain: a randomized, double-blind, placebo-controlled, crossover study. Pain, 2004. 108(1-2): p. 17-27.
26. Lassmann-Vague, V. and D. Raccah, Alternatives routes of insulin delivery. Diabetes Metab, 2006. 32(5 Pt 2): p. 513-22.
27. Eyles, J.E., E.D. Williamson, and H.O. Alpar, Intranasal Administration of InfluenzaVaccines: Current Status. BioDrugs, 2000. 13(1): p. 35-59.
28. Lin, K., Intranasal influenza vaccine may be a safe, effective option for many children. J Pediatr, 2007. 151(1): p. 102-3.
29. Dean, H.J., Alternative routes of influenza vaccine delivery. Expert Opin Drug Deliv, 2006. 3(5): p. 557-61.
30. Slot, W.B., et al., Normalization of plasma vitamin B12 concentration by intranasal hydroxocobalamin in vitamin B12-deficient patients. Gastroenterology, 1997. 113(2): p. 430-3.
31. van Asselt, D.Z., et al., Nasal absorption of hydroxocobalamin in healthy elderly adults. Br J Clin Pharmacol, 1998. 45(1): p. 83-6.