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Intranasal Medications in Pediatric Emergency Medicine

Del Pizzo, Jeannine MD; Callahan, James M. MD

doi: 10.1097/PEC.0000000000000171
CME Review Article

Intranasal medication administration in the emergency care of children has been reported for at least 20 years and is gaining popularity because of ease of administration, rapid onset of action, and relatively little pain to the patient. The ability to avoid a needle stick is often attractive to practitioners, in addition to children and their parents. In time-critical situations for which emergent administration of medication is needed, the intranasal route may be associated with more rapid medication administration. This article reviews the use of intranasal medications in the emergency care of children. Particular attention will be paid to anatomy and its impact on drug delivery, pharmacodynamics, medications currently administered by this route, delivery devices available, tips for use, and future directions.

Attending Physician and Research Fellow (Del Pizzo), Division of Emergency Medicine, The Children’s Hospital of Philadelphia; Attending Physician and Vice Director (Callahan), Division of Emergency Medicine, Pediatric Residency Program, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Professor (Callahan), Clinical Pediatrics Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

The authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations pertaining to this educational activity.

The authors have disclosed that the U.S. Food and Drug Administration has not approved the use of intranasal ketamine and lorazepam for sedation; intranasal naloxone for reversal of opioid overdose; and the devices OptiNose and DirectHaler Nasal to deliver medications intranasally to children as discussed in this article. Please consult the products’ labeling for approved information.

Reprints: Jeannine Del Pizzo, MD, Division of Emergency Medicine, Children’s Hospital of Philadelphia, Colket Translational Research Bldg, 9th Floor, 3501 Civic Center Blvd, Philadelphia, PA 19104 (e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.