From the FDA Drug Label
Directions: Adults and children 6 to under 12 years of age (with adult supervision): 2 or 3 sprays in each nostrill not more often than every 10 to 12 hours. The volume that can be administered intranasally is 2 or 3 sprays in each nostril.
- The maximum number of sprays per nostril is 3.
- The maximum number of doses in a 24-hour period is 2 1.
From the Research
The maximum volume that can be administered intranasally is typically 0.2-0.3 mL per nostril, with a total maximum volume of 0.5-1 mL divided between both nostrils. For optimal absorption, it's best to limit each nostril to no more than 0.2 mL at a time. When administering medications intranasally, use an atomizer device to create a fine mist for better absorption across the nasal mucosa. Position the patient with their head tilted slightly forward or in a neutral position to prevent medication from running down the throat. Common intranasal medications include naloxone (0.1 mL of 1 mg/mL solution per nostril), midazolam (0.2 mL per nostril), and fentanyl (0.1 mL per nostril) 2. The nasal cavity has a rich blood supply and large surface area, allowing for rapid absorption and onset of action while avoiding first-pass metabolism. However, exceeding the recommended volumes can result in medication dripping down the nasopharynx, being swallowed, and losing the benefits of the intranasal route. Some studies have shown that intranasal administration of certain medications can be effective for up to 12 hours, such as oxymetazoline (0.05%) 3. It is essential to follow the recommended guidelines for intranasal medication administration to ensure optimal absorption and minimize potential side effects. Intranasal drug administration is a less invasive method of drug delivery that is easily accessible for adult and pediatric patients, with efficacy comparable to intravenous administration and typically superior to subcutaneous or intramuscular routes 4. The key to successful intranasal medication administration is to use the correct technique, medications, and dosing, as outlined in recent studies 2. By following these guidelines, healthcare providers can effectively utilize the intranasal route for medication administration, improving patient outcomes and quality of life. The most recent and highest quality study on this topic is from 2018, which highlights the importance of proper technique and dosing for intranasal medication administration 4, 2, 3. Overall, the intranasal route is a safe and effective method of medication administration, with a rich blood supply and large surface area allowing for rapid absorption and onset of action.