What is the purpose of intranasal (intra-nasal) administration?

From the Guidelines

Intranasal corticosteroids are the most effective medication class for controlling symptoms of allergic rhinitis, including sneezing, itching, rhinorrhea, and nasal congestion, and should be considered as first-line treatment. When administering intranasal medications, patients should clear their nasal passages first, tilt their head slightly forward, insert the device into one nostril while blocking the other, and breathe in gently during administration 1.

Key Points to Consider

• Intranasal antihistamines may be considered for use as first-line treatment for allergic and nonallergic rhinitis, but they are generally less effective than intranasal corticosteroids for treatment of allergic rhinitis 1.
• Intranasal corticosteroids have been shown to be effective in reducing symptoms of allergic rhinitis, with minimal local side effects when used at recommended doses 1.
• Patients should be instructed to direct sprays away from the nasal septum and to have their nasal septum periodically examined to assure that there are no mucosal erosions 1.
• The combination of intranasal anticholinergics with either antihistamines or intranasal corticosteroids may provide additional benefits in reducing rhinorrhea 1.

Administration and Dosage

• Intranasal corticosteroids should be administered 1-2 sprays per nostril daily, with patients using the lowest effective dose, especially in children 1.
• Intranasal antihistamines may be associated with sedation and can inhibit skin test reactions, and their use should be considered carefully 1.
• Topical decongestants should be used on a short-term basis for nasal congestion associated with acute bacterial or viral infections, exacerbations of allergic rhinitis, and eustachian tube dysfunction, with patients being instructed on the risk of rhinitis medicamentosa when used for more than 3 days 1.

From the FDA Drug Label

Fluticasone Propionate Nasal Spray, USP not only relieves sneezing, itchy nose, runny nose and itchy, watery eyes, but also relieves nasal congestion. The answer to the question Intranasal is:

• Fluticasone Propionate Nasal Spray, USP is an intranasal medication, as indicated by its name and the fact that it is administered via nasal spray.
• It is used to relieve symptoms of allergies, including nasal congestion, sneezing, itchy nose, runny nose, and itchy, watery eyes 2.
• Oxymetazoline (IN) is also an intranasal medication, used as a nasal decongestant to temporarily relieve nasal congestion due to common cold, hay fever, upper respiratory allergies, and sinusitis 3 3.

From the Research

Intranasal Administration

• Intranasal administration is a less invasive method of drug delivery that is easily accessible for adult and pediatric patients 4
• Medications administered by the intranasal route have efficacy comparable to intravenous administration and typically have superior efficacy to subcutaneous or intramuscular routes 4
• The intranasal route is beneficial in emergent situations when the intravenous route is not available 4

Efficacy of Intranasal Corticosteroids

• Intranasal corticosteroids alleviate nasal congestion, along with other symptoms of allergic rhinitis, but their effect is not evident immediately 5
• Fluticasone propionate is a potent topical anti-inflammatory corticosteroid with low systemic activity, and its efficacy in controlling nasal symptoms has been confirmed in large clinical studies 6
• The fixed-dose combination of fluticasone furoate and oxymetazoline hydrochloride nasal spray has been shown to be effective in relieving nasal congestion and reducing total nasal symptom score in patients with allergic rhinitis 5, 7

Safety and Tolerability

• The incidence of adverse effects associated with intranasal fluticasone propionate is comparable to that observed with placebo, with the most frequently reported effects being nasal dryness/burning, epistaxis, and headache 6
• The fixed-dose combination of fluticasone furoate and oxymetazoline hydrochloride nasal spray has been shown to be safe and well-tolerated, with no serious adverse events reported 5, 7
• Oxymetazoline, when used along with a nasal steroid in a once-daily dose, does not cause rebound congestion and rhinitis medicamentosa even after long-term continuous use of 28 days 7

Advantages of Intranasal Administration

• Intranasal administration offers a rapid onset of therapeutic effects (local or systemic) 8
• Nasal application circumvents gastrointestinal degradation and hepatic first-pass metabolism of the drug 8
• Intranasal drug administration is noninvasive, essentially painless, and particularly suited for children 8