Nasal administration
Nasal administration, popularly known as snorting, is a
Risks
Nasal septum perforation
A
Advantages
The nasal cavity is covered by a thin mucosa which is well vascularised.[2] Therefore, a drug molecule can be transferred quickly across the single epithelial cell layer directly to the systemic blood circulation without first-pass hepatic and intestinal metabolism. The effect is often reached within 5 min for smaller drug molecules.[3] Nasal administration can therefore be used as an alternative to oral administration, by crushing or grinding tablets or capsules and snorting or sniffing the resulting powder, providing a rapid onset of effects. If a fast effect is desired or if the drug is extensively degraded in the gut or liver.[4]
Large-molecule drugs can also be delivered directly to the brain by the intranasal route, the only practical means of doing so, following the olfactory and trigeminal nerves (see section below), for widespread central distribution throughout the central nervous system with little exposure to the blood.[5][6][7][8] This delivery method to the brain was functionally demonstrated in humans in 2006, using insulin, a large peptide hormone that acts as a nerve growth factor in the brain.[9]
Limitations
Nasal administration is primarily suitable for potent drugs since only a limited volume can be sprayed into the nasal cavity. Drugs for continuous and frequent administration may be less suitable because of the risk of harmful long-term effects on the nasal epithelium.[4] Nasal administration has also been associated with a high variability in the amount of drug absorbed. Upper airway infections may increase the variability as may the extent of sensory irritation of the nasal mucosa, differences in the amount of liquid spray that is swallowed and not kept in the nasal cavity and differences in the spray actuation process.[10] However, the variability in the amount absorbed after nasal administration should be comparable to that after oral administration.[11][12]
Nasal drugs
The area of intranasal medication delivery provides a huge opportunity for research – both for specifically developed pharmaceutical drugs designed for intranasal treatment, as well as for investigating off label uses of commonly available generic medications. Steroids, and a large number of inhalational anaesthetic agents are being used commonly. The recent developments in intranasal drug delivery systems are prodigious. Peptide drugs (hormone treatments) are also available as nasal sprays, in this case to avoid drug degradation after oral administration. The peptide analogue
Medicines
Oxytocin
Recreational drugs/entheogens
List of substances that have higher bioavailability when administered intranasally compared to oral administration.
Cocaine
Insufflation of cocaine leads to the longest duration of its effects (60–90 minutes).[16] When insufflating cocaine, absorption through the nasal membranes is approximately 30–60%[17]
Ketamine
Among the less invasive routes for ketamine, the intranasal route has the highest bioavailability (45–50%)[18][19]
In ketamine, commonly being used for the treatment of breakthrough pain in patients with chronic pain is now becoming an area of significant research interest for the treatment of bipolar disease and major depressive disorder with early results suggesting a strong and prolonged antidepressant effect following a single subdissociative dose (50 mg) of ketamine.
Snuff
Snuff is a type of smokeless tobacco product made from finely ground or pulverized tobacco leaves.[20] It is snorted or "sniffed" (alternatively sometimes written as "snuffed") into the nasal cavity, delivering nicotine and a flavored scent to the user (especially if flavoring has been blended with the tobacco).[20] Traditionally, it is sniffed or inhaled lightly after a pinch of snuff is either placed onto the back surface of the hand, held pinched between thumb and index finger, or held by a specially made "snuffing" device.
Yopo
Snuff trays and tubes similar to those commonly used for yopo were found in the central Peruvian coast dating back to 1200 BC, suggesting that insufflation of Anadenanthera beans is a more recent method of use.[21] Archaeological evidence of insufflation use within the period 500-1000 AD, in northern Chile, has been reported.[22]
Research
Olfactory transfer
There is about 20 mL capacity in the adult human
The olfactory transfer of drugs into the brain is thought to occur by either slow transport inside the olfactory nerve cells to the olfactory bulb or by faster transfer along the perineural space surrounding the olfactory nerve cells into the cerebrospinal fluid surrounding the olfactory bulbs and the brain (8, 9) [24][25]
Olfactory transfer could theoretically be used to deliver drugs that have a required effect in the central nervous system such as those for Parkinson's or Alzheimer's diseases. Studies have been presented that show that direct transfer of drugs is achievable.[25][26]
References
- PMID 30725893, retrieved 2023-10-17
- ^ D.F. Proctor and I. Andersen. The nose. Upper airway physiology and the atmospheric environment , Elsevier Biomedical Press, Amsterdam, 1982.
- ^ Y.W. Chien, K.S.E. Su, and S.-F. Chang. Nasal systemic drug delivery, Marcel Dekker, Inc., New York, 1989.
- ^ ISBN 978-91-554-7288-7.
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- ^ ISBN 91-554-5834-3. Retrieved 18 March 2023.
- ^ ISBN 978-91-554-6871-2. Retrieved 18 March 2023.
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- ^ H. Kublik and M.T. Vidgren. Nasal delivery systems and their effect on deposition and absorption. Adv Drug Deliv Rev. 29:157-177 (1998).
- ^ B.A. Coda, A.C. Rudy, S.M. Archer, and D.P. Wermeling. Pharmacokinetics and bioavailability of single-dose intranasal hydromorphone hydrochloride in healthy volunteers. Anesth Analg. 97:117-123 (2003).
- ^ J. Studd, B. Pornel, I. Marton, J. Bringer, C. Varin, Y. Tsouderos, and C. Christiansen. Efficacy and acceptability of intranasal 17 beta-oestradiol for menopausal symptoms: randomised dose-response study. Aerodiol Study Group. Lancet. 353:1574-1578 (1999).
- ^ FerringPharmaceuticals. SPC: Minirin nasal spray, Minirin Freeze-dried tablet and Minirin tablet, 2005.
- ^ H.R. Costantino, L. Illum, G. Brandt, P.H. Johnson, and S.C. Quay. Intranasal delivery: physicochemical and therapeutic aspects. Int J Pharm. 337:1-24 (2007).
- ^ Baig AM, Khan NA. Novel chemotherapeutic strategies in the management of primary amoebic meningoencephalitis due to Naegleria fowleri.CNS Neurosci Ther. 2014 Mar;20(3):289-90. doi: 10.1111/cns.12225. Epub 2014 Jan 24
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- ^ "The Dangers Of Snorting Cocaine (Insufflation)". Vertava Health. Retrieved 2022-02-25.
- ISBN 978-3-319-42925-0. Archivedfrom the original on 8 September 2017.
- PMID 23521979.
- ^ a b
The Old Snuff House of Fribourg & Treyer at the Sign of the Rasp & Crown, No.34 James's Haymarket, London, S.W., 1720, 1920. Author: George Evens and Fribourg & Treyer. Publisher: Nabu Press, London, England. Reproduced 5 August 2010, ISBN 978-1176904705
- ^ Cortella, M. Ruiz. 1995 [full citation needed]
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- ^ Troy, David; Beringer, Paul, eds. (2006). "39". Remington: The Science and Practice of Pharmacy. Lippincott Williams & Wilkins. p. 752.
- ^ S. Mathison, R. Nagilla, and U.B. Kompella. Nasal route for direct delivery of solutes to the central nervous system: Fact or fiction? J Drug Target. 5:415-441 (1998)
- ^ a b L. Illum. Is nose-to-brain transport of drugs in man a reality? J Pharm Pharmacol. 56:3-17 (2004).
- ^ U.E. Westin, E. Bostrom, J. Grasjo, M. Hammarlund-Udenaes, and E. Bjork. Direct nose-to-brain transfer of morphine after nasal administration to rats. Pharm Res. 23:565-572 (2006).