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Simpler Medication Administration Nosing Out Other Techniques

MAYWOOD, IL – For a growing number of medications administered in the emergency department, there is no need to have patients roll up their sleeves or drop trousers. Instead, the nostrils are becoming the preferred route, according to an article published recently in Annals of Emergency Medicine.

The article entitled, "When to Pick the Nose: Out-of-Hospital and Emergency Department Intranasal Administration of Medication,” looked at common medications that can be dosed through a nose spray, including midazolam, fentanyl, naloxone, ketamine, and dexmedetomidine.

“For patients who are combative or having seizures, intranasal administration of certain medications can be really helpful,” explained lead study author Megan Rech, PharmD, MS, BCPS, BCCP, of Loyola University Medical Center in Maywood, IL. “These formulations can be especially useful for children, as they are not as painful and frightening as using intravenous or intramuscular routes. This route can also be an effective option for treating opioid overdoses.”

Examples of drugs that can be administered through the nasal route using an atomizer include midazolam to sedate children for emergency procedures, as well as to treat seizures in children and adults. “Several small studies (mostly pediatric) have shown midazolam to be effective for procedural sedation, anxiolysis, and seizures,” the authors note.


They also cite data indicating that intranasal fentanyl is safe and effective for relieving acute pain.

The study emphasizes that the intranasal route is especially effective when using naloxone as a first-line therapy in suspected opioid overdoses, especially when there is no intravenous access. That route even allows administration by out-of-hospital personnel or non-clinicians, the authors point out.

Researchers note that the intranasal route probably is effective for the following but the literature is less clear:

  • Ketamine for orthopedic injuries or for patients who are undergoing nasogastric tube placement;
  • Intranasal dexmedetomidine for sedation and pain relief for surgical and dental procedures in children.

“Administering medications intranasally in the pre-hospital or emergency setting can be easy, fast and non-invasive,” Rech added. “It is a welcome option for emergency physicians treating a wide variety of patients, sometimes in difficult situations.”