GO MEDICAL NASAL SPRAYS
Drugs delivered to the nasal mucosa act as quickly as intravenous injections. The nasal route avoids hepatic first pass metabolism that vastly reduces the bioavailability of some oral medications. The Go Medical nasal sprays are hand activated sprays that are highly acceptable to patients. There are a range to choose from, lock out PCA sprays, Variable Dose sprays and Single Dose sprays.There can be varied applications and adaptations for these sprays. They are suitable for use with fentanyl, alfentanyl and meperidine. The spray is delivered in a small droplet form, reducing the volume of drug reaching the nasopharynx. Applications include preemptive analgesia (e.g. dressing changes for patients with burns) moderate to severe pain in children and adults, and palliative care.
Introduction:
Lock out PCA Nasal Sprays:
It is a new method of delivering PRN Opioids. Reviews conducted demonstrated that with the prescribing of PRN opioids, patients received only 25% of the total dose of opioids available to them in the first 48 hours. Approximately 70% of these patients considered that they had received inadequate treatment of their pain (1).
Since that time patient controlled analgesia has been shown to be significantly more effective than intramuscular injections. The patient benefits partly by having the minimum delay between the onset of pain and treatment, and by having benefits relating to direct control of their analgesia.
Recently the benefits attributed to intravenous patient controlled analgesia have also been demonstrated with intranasal PCA and with oral PCA (2,3,4).
This new method of prescribing PRN opioids brings PRN closer to the original meaning “when required”. It facilitates your patient being offered superior pain control without drips, expensive pumps, injections or major changes in prescribing.
Directions for Use:
The bottle can be filled with neat fentanyl (50mcg/ml) or neat Pethidine (50mg/ml). This will deliver a nominal 0.18mlspray delivering either 8-9mcg of Fentanyl or 8-9mg of Pethidine. Lock out is determined by which bottle you use. Approximately 70% of each of these drugs are absorbed. Lock outs 3, 4 and 5 minutes are available.
Variable dose Sprays:
Then there are certain drugs that require the dose or volume of drug to be titrated for each dose. Initially, the Variable Dose Spray was designed to deliver Intranasal Insulin. Upon reading of blood glucose, a dose can be selected to best deliver a suitable dose of Insulin.
Single Dose Nasal Sprays:
This is perhaps a very interesting spray in that it delivers only ONE dose of a designated drug. A many varied intranasal applications. Pain management drugs, anti-addiction drugs, allergy drugs, almost any applications that requires a dose of drug.
The spray is designed to deliver only one dose. The spray can be discarded upon single use. However, you can also “change” the ampoule in the dispensing spray and hence work out a different routine for drug administration. A blister pack of medication can even pre-made if this is desired.
References:
- Marks R.M., Annals of Int Medicine 1973; 78: 173-81
- H.W. Streibel PCA and Acceptance of Patinet Controlled Intranasal Analgesia, J of Clinical Anaesthesia 8:4-8 1996
- R. Schwagmeier, Patients assessment and acceptance of Patient Controlled analgesia. Anaesthetist (1996) 45: 231-234.
- H.W. Streibel et.al. Intranasal Meperidine Titration for postoperative Pain Relief. Anaeth Analg 1993: 76: 1047-51