Drug delivery via the upper nasal space: A novel route for anesthesiologists, intensivists and emergency department physicians?

Stephen Shrewsbury, Jasna Hocevar-Trnka, and John Hoekman

Full manuscript can be accessed here: https://probiologists.com/Uploads/Articles/10_637521815510349420.pdf

Many drugs are effective systemically, but slow onset of non-intravenous routes of administration may limit their clinical utility. While anesthesiologists usually have intravenous (IV) access for drug delivery, other healthcare professionals in less controlled situations such as acute crises in the emergency room, critical care settings, or urgent needs in the community, may need non-invasive drug delivery.

One such situation is acute agitation. Limited approved options for the management of this difficult situation can lead to many hours of “boarding”, where initial administration of strong sedatives can lead to heavily sedated patients lying on a gurney for several hours in the Emergency Department (ED). In turn this can delay diagnosis, appropriate triage and initiation of definitive treatment. Boarding increases the cost of observation and blocks ER access for other patients. There are even fewer options for treating acute agitation in the community creating a large unmet need. Delivery of a second generation antipsychotic, olanzapine, to the upper nasal space resulting in rapid blood levels to match those after intramuscular injection may address that need. This commentary refers to the recent phase 1 safety, pharmacokinetic (PK), and pharmacodynamic (PD) study in healthy adult volunteers, SNAP 101, which compared the results from the Precision Olfactory Delivery (or POD® ) device, to intramuscular (IM) injection, and to oral disintegrating tablet (ODT) and may suggest a future suitable option.

Shrewsbury et al., J Clin Anesth Intensive Care 2021; 2(1): 8-14

To cite: Shrewsbury S, Hocevar-Trnka J, Hoekman J. Drug delivery via the upper nasal space: A novel route for anesthesiologists, intensivists and emergency department physicians? J Clin Anesth Intensive Care. 2021; 2(1): 8-14.