Chapter 15: Medicines optimization: ensuring quality and safety
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Nasal administration
Definition
Nasal administration involves introducing medication into the cavity of the nose for local or systemic effects (Aldridge [4]).
Related theory
The nasal passages are lined with highly vascular mucous membranes covered with ciliated epithelium, which warms and moistens air and traps dust. Medication can be delivered directly to the nasal cavity to relieve local symptoms, such as allergic rhinitis, in the form of nasal drops or nasal sprays (Aldridge [4]). Nasal ointments are used to treat and prevent infections in the nasal cavity.
The nasal cavity can also be used to allow the delivery of drugs systemically. Examples include sumatriptan for migraine, desmopressin for the treatment of diabetes insipidus, and nocturia and fentanyl for the treatment of breakthrough pain.
Evidence‐based approaches
The advantages of the delivery of drugs using the nasal route include:
- the large vascular surface of the nasal cavity, which allows rapid absorption
- the avoidance of first‐pass metabolism
- the accessibility of the nose
- the ease of administration
- the fact that this route can be used when patients are unable to swallow.
There are some disadvantages to the nasal route, including:
- the presence of mucus, which acts as a barrier to absorption
- mucociliary clearance, which reduces the time that drugs are held in the nasal cavity
- colds can affect absorption from the nasal cavity
- some drugs may irritate the nasal cavity.
Pre‐procedural considerations
Specific patient preparation
The patient should be encouraged to clear their nostrils by blowing or manually cleaning with a tissue or damp cotton bud to ensure that the drug has access to the nasal mucosa (Aldridge [4]).
Procedure guideline 15.9
Medication: nasal drop administration
Post‐procedural considerations
The patient should be discouraged from sniffing too vigorously post‐administration as this can cause ‘run‐off’ of the medication down the nasopharynx. This can cause an unpleasant taste in the throat and affect absorption of the medication (Aldridge [4]).
