Table 1. Profile of Analgesics Administered via the Intranasal Route.
| Drug | Available intranasal products | Pharmacokinetics | Intranasal dose | Adverse effectsa |
|---|---|---|---|---|
| Fentanyl [28, 41, 43-45, 50, 51] | Fentanyl citrate 50 µg/mL solution | Bioavailability: 55-89% | Adult: initial dose of 0.5 - 2 µg/kg (maximum of 100 µg/dose) | Nasal congestion, throat irritation, headache, unpleasant taste |
| Onset of action: 2 - 10 min | ||||
| Peak effect: 12 - 21 min | Pediatric (≥ 1 year old and weighing at least 10 kg): initial dose of 1 - 1.5 µg/kg (maximum of 100 µg/dose) | |||
| Duration of action: at least 60 minb | ||||
| Hydromorphone [28, 53-56] | Hydromorphone hydrochloride 1 mg/mL | Bioavailability: 50-60% | Adult: initial dose 4 - 8 mg | Unpleasant taste, dizziness, rhinitis |
| Onset of action: about 5 min | ||||
| Peak effect: 20 - 30 min | Pediatric: 0.03 - 0.06 mg/kgc | |||
| Duration of action: 90 - 180 min | ||||
| Ketorolac [57, 59, 63-67] | 8 sprays/1.7 g nasal spray bottle of ketorolac tromethamine (1 spray is equivalent to 15.75 mg in a 100 µL solution) | Bioavailability: 67-75% | Adult: < 65 years: one 15.75 mg spray in each nostril (31.5 mg/dose) every 6 - 8 h (maximum dose of 63 mg/day) | Nasal irritation, dysgeusia |
| Onset of action: 5 - 20 min | ≥ 65 years of age, renal impairment, weight < 50 kg: one 15.75 mg spray in one nostril (15.75 mg/dose) | |||
| Peak effect: 30 - 52 min | Pediatric: not recommended | |||
| Duration of action: about 180 min |
aAdverse events due to local effect of medication, medication-specific systemic adverse events not included. bDepend on dosage. cLimited evidence on pediatric use.