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Micaelabrody (talk | contribs) removed ibuprofen and tylenol section; discussing these specific painkillers' uses is irrelevant to the specific nasal administration discussed in the opening paragraph and given its random placement i believe it was included/pasted accidentally |
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[[File:Instilling nasal medication.jpg|thumb|A medical professional applies nose drops.]]
'''Nasal administration''', popularly known as '''snorting''', is a [[route of administration]] in which [[drug]]s are [[insufflation (medicine)|insufflated]] through the [[nose]]. It can be a form of either [[topical administration]] or [[systemic administration]], as the drugs thus locally delivered can go on to have either purely local or systemic effects
==Risks==
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A [[nasal septum perforation]] is a medical condition in which the [[nasal septum]], the [[cartilage|bony/cartilaginous]] wall dividing the [[nostrils|nasal cavities]], develops a hole or fissure.<ref>{{Citation |last1=Downs |first1=Brian W. |title=Septal Perforation |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK537208/ |work=StatPearls |access-date=2023-10-17 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30725893 |last2=Sauder |first2=Haley M.}}</ref>
Sharing snorting equipment (nasal spray bottles, straws, banknotes, bullets, etc) has been linked to the transmission of [[hepatitis C]]. (Bonkovsky and Mehta) In one study, the University of Tennessee Medical Center researches warned that other blood-borne diseases such as [[HIV]], the [[AIDS]]-causing virus, could be transmitted as well.<ref>{{Citation | year=2016 | title=Sharing Drug "Snorting Straws" Spreads Hepatitis C | url=https://consumer.healthday.com/infectious-disease-information-21/hepatitis-news-373/sharing-drug-snorting-straws-spreads-hepatitis-c-713114.html}}</ref>
===Risk factors for shared drug paraphernalia===
[[File:Cocaine lines 2.jpg|thumb|left|Lines of cocaine prepared for snorting. [[Contaminated currency]] such as banknotes might serve as a [[fomite]] of diseases like [[hepatitis C]]<ref name="LV">{{cite web |url=http://cocaine.org/cokemoney/banknotes.html |title='Shared banknote' health warning to cocaine users |accessdate=2008-07-26 |author=Laureen Veevers |date=1 October 2006 |work=The Observer }}</ref>]]
Sharing snorting equipment (straws, banknotes, bullets, etc) has been linked to the transmission of hepatitis C. (Bonkovsky and Mehta) In one study, the University of Tennessee Medical Center researches warned that other blood-borne diseases such as HIV, the AIDS-causing virus, could be transmitted as well.<ref>{{Citation | year=2016 | title=Sharing Drug “Snorting Straws” Spreads Hepatitis C | url=https://consumer.healthday.com/infectious-disease-information-21/hepatitis-news-373/sharing-drug-snorting-straws-spreads-hepatitis-c-713114.html}}</ref> Drinking makes it harder to resist pressure and clouds your ability to make safe choices. Not only might you miss signs of danger, like blood stains on shared equipment, but alcohol weakens your immune system, making it easier to catch and spread viruses.
== Advantages ==
The nasal cavity is covered by a thin mucosa which is well vascularised.<ref>D.F. Proctor and I. Andersen. The nose. Upper airway physiology and the atmospheric environment , Elsevier Biomedical Press, Amsterdam, 1982.</ref> Therefore, a drug molecule can be transferred quickly across the single epithelial cell layer directly to the systemic blood circulation without first-pass hepatic and intestinal metabolism. The effect is often reached within 5 min for [[Small molecule|smaller drug molecules]].<ref>Y.W. Chien, K.S.E. Su, and S.-F. Chang. Nasal systemic drug delivery, Marcel Dekker, Inc., New York, 1989.</ref> Nasal administration can therefore be used as an alternative to oral administration, by crushing or grinding tablets or capsules and snorting or sniffing the resulting powder, providing a rapid onset of effects. If a fast effect is desired or if the drug is extensively degraded in the gut or liver
Large-molecule drugs can also be delivered directly to the brain by the intranasal route, the only practical means of doing so, following the olfactory and trigeminal nerves [[Nasal administration#Olfactory transfer|(see section below)]], for widespread central distribution throughout the [[central nervous system]] with little exposure to the blood.<ref name="Thorne 1995">{{cite journal |last1=Thorne |first1=RG |last2=Emory |first2=ER |last3=Ala |first3=TA |last4=Frey |first4=William II |title=Quantitative analysis of the olfactory pathway for drug delivery to the brain |journal=Brain Research |date=September 18, 1995 |volume=692 |issue=1–2 |pages=278–282 |doi=10.1016/0006-8993(95)00637-6 |pmid=8548316|s2cid=11522233 }}</ref><ref name="Thorne 2004">{{cite journal |last1=Thorne |first1=RG |last2=Pronk |first2=GJ |last3=Padmanabhan |first3=V |last4=Frey |first4=WH II |title=Delivery of insulin-like growth factor-I to the rat brain and spinal cord along olfactory and trigeminal pathways following intranasal administration |journal=Neuroscience |date=2004 |volume=127 |issue=2 |pages=481–96 |doi=10.1016/j.neuroscience.2004.05.029 |pmid=15262337|s2cid=40872017 }}</ref><ref name="Björn">{{cite thesis |last=Jansson |first=Björn |date=2004 |title=Models for the Transfer of Drugs from the Nasal Cavity to the Central Nervous System |type=PhD dissertation |publisher=Uppsala University |url=http://urn.kb.se/resolve?urn=urn%3Anbn%3Ase%3Auu%3Adiva-3905 |access-date=18 March 2023 |isbn=91-554-5834-3}}</ref><ref name="Ulrika">{{cite thesis |last=Espefält Westin |first=Ulrika |date=2007 |title=Olfactory Transfer of Analgesic Drugs After Nasal Administration |type=PhD dissertation |publisher=Uppsala University |url=http://urn.kb.se/resolve?urn=urn%3Anbn%3Ase%3Auu%3Adiva-7829 |access-date=18 March 2023 |isbn=978-91-554-6871-2}}</ref> This delivery method to the brain was functionally demonstrated in humans in 2006, using [[insulin]], a large [[peptide]] hormone that acts as a nerve growth factor in the brain.<ref name="Reger 1">{{cite journal |last1=Reger |first1=MA |last2=Watson |first2=GS |last3=Frey |first3=WH II |last4=Baker |first4=LD |last5=Cholerton |first5=B |last6=Keeling |first6=ML |last7=Belongia |first7=DA |last8=Fishel |first8=MA |last9=Plymate |first9=SR |last10=Belongia |first10=GD |last11=Cherrier |first11=MM |last12=Craft |first12=S |title=Effects of intranasal insulin on cognition in memory-impaired older adults: modulation by APOE genotype |journal=Neurobiol Aging |date=March 2006 |volume=27 |issue=3 |pages=451–458 |doi=10.1016/j.neurobiolaging.2005.03.016 |pmid=15964100|s2cid=21158378 }}</ref>
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== Limitations ==
Nasal administration is primarily suitable for potent drugs since only a limited volume can be sprayed into the nasal cavity. Drugs for continuous and frequent administration may be less suitable because of the risk of harmful long-term effects on the nasal epithelium.<ref name="Fransén 2008"/> Nasal administration has also been associated with a high variability in the amount of drug absorbed. Upper airway infections may increase the variability as may the extent of sensory irritation of the nasal mucosa, differences in the amount of liquid spray that is swallowed and not kept in the nasal cavity and differences in the spray actuation process.<ref>H. Kublik and M.T. Vidgren. Nasal delivery systems and their effect on deposition and absorption. Adv Drug Deliv Rev. 29:157-177 (1998).</ref> However, the variability in the amount absorbed after nasal administration should be comparable to that after oral administration.<ref>B.A. Coda, A.C. Rudy, S.M. Archer, and D.P. Wermeling. Pharmacokinetics and bioavailability of single-dose intranasal hydromorphone hydrochloride in healthy volunteers. Anesth Analg. 97:117-123 (2003).</ref><ref>J. Studd, B. Pornel, I. Marton, J. Bringer, C. Varin, Y. Tsouderos, and C. Christiansen. Efficacy and acceptability of intranasal 17 beta-oestradiol for menopausal symptoms: randomised dose-response study. Aerodiol Study Group. Lancet. 353:1574-1578 (1999).</ref>
== Nasal drugs ==
The area of intranasal medication delivery provides a huge opportunity for research – both for specifically developed pharmaceutical drugs designed for intranasal treatment, as well as for investigating off label uses of commonly available generic medications. Steroids,
===Medicines===
===
[[Oxytocin (medicine)|Oxytocin]] (brand name Syntocinon) nasal spray is used to increase duration and strength of contractions during labour. Intranasal oxytocin is also being actively investigated for many psychiatric conditions including alcohol withdrawal, anorexia nervosa, PTSD, autism, anxiety disorders, pain sensation and schizophrenia.
===Recreational drugs/entheogens===▼
List of substances that have higher bioavailability when administered intranasally compared to oral administration.
▲===Recreational drugs/entheogens===
====Cocaine====
Insufflation of [[cocaine]] leads to the longest duration of its effects (60–90 minutes).<ref name="Zimmerman2012">{{Cite journal | vauthors = Zimmerman JL | title = Cocaine intoxication | journal = Critical Care Clinics | volume = 28 | issue = 4 | pages = 517–26 | date = October 2012 | pmid = 22998988 | doi = 10.1016/j.ccc.2012.07.003 }}</ref> When insufflating cocaine, absorption through the nasal membranes is approximately 30–60%<ref>{{Cite web|title=The Dangers Of Snorting Cocaine (Insufflation)|url=https://vertavahealth.com/cocaine/insufflation/|access-date=2022-02-25|website=Vertava Health|language=en-US}}</ref>
====Ketamine====
[[Image:SpiRaL.jpg|thumb|left|[[Ketamine]] prepared in a spiral for "[[Insufflation (medicine)|snorting]]". a common technique for self-administration of some recreational drugs.]]
Among the less invasive routes for [[ketamine]], the intranasal route has the highest bioavailability (45–50%)<ref name="MathewZarate2016">{{cite book | vauthors = Mathew SJ, Zarate Jr CA |title=Ketamine for Treatment-Resistant Depression: The First Decade of Progress |url=https://books.google.com/books?id=QDOgDQAAQBAJ&pg=PA22 |date=25 November 2016 |publisher=Springer |isbn=978-3-319-42925-0 |pages=8–10, 14–22 |url-status=live |archive-url=https://web.archive.org/web/20170908185726/https://books.google.com/books?id=QDOgDQAAQBAJ&pg=PA22 |archive-date=8 September 2017 }}</ref><ref name="pmid23521979">{{cite journal |vauthors=Marland S, Ellerton J, Andolfatto G, Strapazzon G, Thomassen O, Brandner B, Weatherall A, Paal P |title=Ketamine: use in anesthesia |journal=CNS Neurosci Ther |volume=19 |issue=6 |pages=381–9 |date=June 2013 |pmid=23521979 |pmc=6493613 |doi=10.1111/cns.12072 }}</ref>
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====Snuff====
[[Snuff (tobacco)|Snuff]] is a type of [[smokeless tobacco]] [[List of tobacco products|product]] made from finely ground or pulverized [[tobacco]] leaves.<ref name="OSHFT">
The Old Snuff House of Fribourg & Treyer at the Sign of the Rasp & Crown, No.34 James's Haymarket, London, S.W., 1720, 1920. Author: George Evens and Fribourg & Treyer. Publisher: Nabu Press, London, England. Reproduced 5 August 2010, {{ISBN|978-1176904705}}
</ref> It is [[Insufflation (medicine)|snorted]] or "sniffed" (alternatively sometimes written as "snuffed") into the nasal cavity, delivering [[nicotine]] and a flavored scent to the user (especially if flavoring has been blended with the tobacco).<ref name="OSHFT" /> Traditionally, it is sniffed or inhaled lightly after a pinch of snuff is either placed onto the back surface of the [[hand]], held pinched between thumb and index finger, or held by a specially made "snuffing" device.
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The '''olfactory transfer''' of drugs into the brain is thought to occur by either slow transport inside the olfactory nerve cells to the olfactory bulb or by faster transfer along the perineural space surrounding the olfactory nerve cells into the cerebrospinal fluid surrounding the olfactory bulbs and the brain (8, 9) <ref>S. Mathison, R. Nagilla, and U.B. Kompella. Nasal route for direct delivery of solutes to the central nervous system: Fact or fiction? J Drug Target. 5:415-441 (1998)</ref><ref name="auto">L. Illum. Is nose-to-brain transport of drugs in man a reality? J Pharm Pharmacol. 56:3-17 (2004).</ref>
Olfactory transfer could theoretically be used to deliver drugs that have a required effect in the central nervous system such as those for Parkinson's or Alzheimer's diseases. Studies have been presented that show that direct transfer of drugs is achievable.<ref name="auto"/><ref>U.E. Westin, E. Bostrom, J. Grasjo, M. Hammarlund-Udenaes, and E. Bjork. Direct nose-to-brain transfer of morphine after nasal administration to rats. Pharm Res. 23:565-572 (2006).</ref>
== References ==
{{Reflist}}
{{Dosage forms
{{Nasal preparations}}
{{DEFAULTSORT:Nasal Administration}}
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