NEFFY Second Dose Administration
Yes, if a second dose of NEFFY is needed, it should be administered in the same nostril as the first dose, starting 5 minutes after the initial administration. 1
Dosing Instructions for Repeat Administration
The FDA-approved prescribing information explicitly states that "if a second dose of neffy is needed, administer a new nasal spray into the same nostril starting 5 minutes after the first dose." 1
Each NEFFY nasal spray is a single-use device that delivers the entire dose upon activation and cannot be primed or reused. 1
The second dose requires using a completely new nasal spray device, not attempting to reuse the first one. 1
Proper Administration Technique
Insert the nozzle of the nasal spray fully into one nostril until your fingers touch the nose. 1
Hold the nasal spray straight into the nose—do not angle it toward the inner septum or outer wall of the nose, as some medication may be lost. 1
Press the plunger firmly to activate and avoid sniffing during and after administration. 1
For the second dose, use the exact same nostril with a new device, maintaining the same straight-in positioning. 1
Clinical Context and Timing
The 5-minute interval between doses allows time to assess clinical response before administering additional epinephrine. 1
Patients should be advised to seek emergency medical assistance regardless of whether symptoms improve, as close monitoring of the anaphylactic episode is essential. 1
More than two sequential doses of epinephrine should only be administered under direct medical supervision. 1
Important Prescribing Considerations
It is recommended that patients are prescribed and have immediate access to two NEFFY nasal sprays at all times, ensuring availability for potential repeat dosing. 1
The pharmacokinetic profile of NEFFY demonstrates a mean peak plasma level of 481 pg/mL, which falls between EpiPen (753 pg/mL) and manual intramuscular injection (339 pg/mL), with pharmacodynamic responses comparable to or better than approved injection products. 2
When dosed both once and twice, NEFFY resulted in more pronounced increases in pharmacodynamic parameters (pulse rate and blood pressure) relative to EpiPen or manual injection, confirming activation of α and β adrenergic receptors within one minute of administration. 2, 3
Common Pitfalls to Avoid
Do not alternate nostrils—both doses must be given in the same nostril to ensure consistent drug delivery. 1
Do not wait longer than necessary to administer the second dose if clinical improvement is absent or symptoms worsen, but do allow at least 5 minutes between doses. 1
Absorption of NEFFY may be affected by underlying structural and anatomical nasal conditions (polyps, history of nasal fractures or injuries, or history of nasal surgery), so consider alternative epinephrine products for patients with these conditions. 1