UMEM Educational Pearls

Category: Pharmacology & Therapeutics

Title: Intranasal Administration of Common Emergency Department Medications

Keywords: Intranasal Administration, Alternative Administration (PubMed Search)

Posted: 11/2/2018 by Wesley Oliver (Emailed: 11/3/2018) (Updated: 11/8/2018)
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The most common methods of medication administration in the emergency department are oral, intravenous (IV), and intramuscular (IM). If the oral route is not available, if IV/IM are not necessary, or if obtaining IV access is challenging, intranasal (IN) medication delivery is a reasonable alternative. More concentrated products are preferred and a volume of 1 mL or less per nostril should be utilized. Below is a table of the commonly used medications used via the IN route.

Drug	Concentration	Indication	IN Dose	Time to Peak Effect	Adverse Events
Fentanyl	50 mcg/mL	Analgesia	0.5-2 mcg/kg	5 min	Nasal irritation, rhinitis, headache
Ketamine	100 mg/mL	Analgesia, Agitation, Sedation	3-6 mg/kg	5-10 min	Poor taste, HTN, hypersalivation, agitation, emergence reaction
Lorazepam	2 mg/mL	Agitation, Seizures	0.1 mg/kg Max: 4 mg	30 min	Poor taste, lacrimation, nasal/throat irritation
Midazolam	5 mg/mL	Agitation, Sedation, Seizures	0.1-0.4 mg/kg Max: 10 mg	5-10 min	Same as lorazepam
Naloxone	1 mg/mL	Opioid Reversal	0.1 mg/kg Usual dose: 0.4-2 mg	1-5 min	N/V, headache, withdrawal symptoms

References

Bailey AM, Baum RA, Horn K, et al. Review of intranasally administered medications for use in the emergency department. J Emerg Med. 2017;53:38-48.