According to a review published in the Journal of Emergency Medicine, intranasal (IN) medication delivery is a viable, safe and effective alternative to intramuscular (IM) and intravenous administration (IV) for a number of emergency medicines.

While oral administration is often considered the preferred route, in the emergency department (ED) this method may not always be possible. IN administration has been shown to be a viable alternative to more invasive methods including IM and IV administration. IN administration can be beneficial in the ED because it bypasses the risk of needle-stick injuries and may be used on a variety of patients. It has also been shown to decrease time to drug administration compared to the IV route which is particularly important in urgent situations such as seizure and trauma management and when dealing with agitated or combative patients. 

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In this study, researchers reviewed the evidence on the use of IN administration for several medications commonly used in the ED including sedative-hypnotics (midazolam, lorazepam, dexmedetomidine, ketamine), analgesics (fentanyl, hydromorphone), agents for reversal sedation or analgesia (flumazenil, naloxone) and the antipsychotic haloperidol.

For analgesia, fentanyl, ketamine, and hydromorphone have been shown to be effective intranasally. IN ketamine has also been used for sedation and to treat agitation, depression, and migraine. Apart from treating agitation, IN lorazepam and midazolam have been used for seizure cessation. In addition, several studies indicate that IN administration of naloxone is effective in opioid reversal, while the use of IN flumazenil for reversal of sedation from benzodiazepines appears to have several limitations. While IN haloperidol may be advantageous for clinicians in treating acute agitation, there is limited data regarding its use or its effectiveness compared to IM administration.

The authors conclude that the “use of IN medications is becoming a common alternate route of administration in the emergency department setting as well at the prehospital and outpatient settings; further showing the importance of providers becoming more familiar with this route of medication delivery.”

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