Clinical and pharmacokinetics overview of intranasal administration of fentanyl

Samaneh Nakhaee; Farhad Saeedi; Omid Mehrpour

doi:10.1016/j.heliyon.2023.e23083

Clinical and pharmacokinetics overview of intranasal administration of fentanyl

Heliyon. 2023 Dec 1;9(12):e23083. doi: 10.1016/j.heliyon.2023.e23083. eCollection 2023 Dec.

Authors

Samaneh Nakhaee¹, Farhad Saeedi^{1

2}, Omid Mehrpour^{3

4}

Affiliations

¹ Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran.
² Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran.
³ Michigan Poison & Drug Information Center, Wayne State University School of Medicine, Detroit, MI, USA.
⁴ AI and Health LLC, Tucson, AZ, USA.

Abstract

Due to the presence of large surfaces and high blood supply, drug delivery through the nasal route of administration is the appropriate route to administrate drugs with rapid onsets of action. Bypassing first-pass metabolism can increase drug bioavailability. The physicochemical properties of fentanyl led to a need to develop formulations for delivery by multiple routes. Several approved inter-nasal fentanyl products in Europe and the USA have been used in prehospital and emergency departments to treat chronic cancer pain and used to treat severe acute abdominal and flank pain. Analgesia durations and onsets were not significantly different between intranasal and intravenous fentanyl in patients with cancer breakthrough pain and were well-tolerated in the long term. Intranasal Fentanyl (INF) at a 50 μg/ml concentration decreased renal colic pain to the lowest level in 30 min. Possible adverse effects specific to INF are epistaxis, nasal wall ulcer, rhinorrhea, throat irritation, dysgeusia, nausea, and vomiting. However, there is limited available literature about the serious adverse effects of INF in adults and children. Intranasal Fentanyl Spray (INFS) results in significantly higher plasma concentrations and has a lower T_max than oral transmucosal formulation, and the bioavailability of fentanyl in intranasal formulations is very high (89 %), particularly in pectin-containing formulations such as PecFent and Lazanda.

Keywords: Fentanyl; Intranasal; Intranasal opioid; Nasal rout.

Publication types

Review