Farmacoriflessioni
Farmaci intranasali nel bambino: cosa devono sapere i pediatri
Intranasal drugs in children, what pAediatricians need to know
Daniela Nisticň1, Federico Marchetti2, Laura Badina3, Egidio Barbi1,3, Giorgio Cozzi3
1Universitŕ di Trieste
2UOC di Pediatria e Neonatologia, Ospedale di Ravenna, AUSL della Romagna
3IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
Giugno 2023 - pagg. 381 -389 | DOI: 10.53126/MEB42381
Abstract
The use of the intranasal route of administration to deliver drugs in children has become more and more popular in the last decades. Seizure, severe acute pain and severe hypoglycaemia in diabetic patients may be managed with intranasal drugs. The intranasal administration is minimally invasive, not painful, needleless and easy to learn and use. The evidence shows that it is a safe and effective way to deliver lipophilic drugs that are quickly absorbed. This article is a practical guide that provides indications, dosages and some “tricks” for this way of administration.
Riassunto
La via intranasale per somministrare farmaci nei bambini č diventata sempre piů popolare negli ultimi decenni. Le convulsioni, il dolore acuto grave e l'ipoglicemia grave nei pazienti diabetici possono essere gestiti con farmaci intranasali. La somministrazione intranasale č minimamente invasiva, non dolorosa, senza ago e di facile apprendimento e utilizzo. Le prove dimostrano che č un modo sicuro ed efficace per fornire farmaci lipofili che vengono rapidamente assorbiti. Questo articolo č una guida pratica che fornisce indicazioni, dosaggi e alcuni “trucchi” per questa modalitŕ di somministrazione.
Classificazione MeSH
Contenuto riservato
Per leggere l'articolo completo è necessario effettuare il login.
Non sei ancora registrato? Registrati
Bibliografia
1. Rech MA, Barbas B, Chaney W, Greenhalgh E, Turck C. When to Pick the Nose: Out-of-Hospital and Emergency Department Intranasal Administration of Medications. Ann Emerg Med 2017:1-9. doi: 10.1016/j.annemergmed.2017.02.015.
2. Bailey AM, Baum RA, Horn K, et al. Review of Intranasally Administered Medications for Use in the Emergency Department. J Emerg Med 2017;53(1):38-48. doi: 10. 1016/j.jemermed.2017.01.020.
3. Intranasal midazolam versus intravenous/rectal benzodiazepines for acute seizure control in children: A systematic review and meta-analysis. Epilepsy Behav 2021;125: 108390. doi: 10.1016/j.yebeh.2021.108390.
4. Holsti M, Dudley N, Schunk J, et al. Intranasal midazolam vs rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy. Arch Pediatr Adolesc Med 2010;164(8):747-53. doi: 10.1001/archpediatrics.2010.130.
5. Arya R, Gulati S, Kabra M, Sahu JK, Kalra V. ntranasal versus intravenous lorazepam for control of acute seizures in children: a randomized open-label study. Epilepsia 2011;52(4):788-93. doi: 10.1111/j.1528-1167.2010.02949.x.
6. Mcintyre J, Robertson S, Norris E, et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Lancet 2005;366(9481):205-10. doi: 10.1016/S0140-6736(05)66909-7.
7. Moretti R, Julliand S, Rinaldi VE, Titomanlio L. Buccal Midazolam Compared With Rectal Diazepam Reduces Seizure Duration in Children in the Outpatient Setting. Pediatr Emerg Care 2019;35(11):760-4. doi: 10.1097/ PEC.0000000000001114.
8. Alansari K, Pem F, Barkat M, et al. Pediatric Neurology Intramuscular Versus Buccal Midazolam for Pediatric Seizures : A Randomized Double-Blinded Trial. Pediatr Neurol 2020;109(26999):28-34. doi: 10.1016/j.pediatrneurol.2020.03.011.
9. Welch RD, Nicholas K, Durkalski-mauldin VL, et al.; Neurological Emergencies Treatment Trials (NETT) Network Investigators. Intramuscular midazolam versus intravenous lorazepam for the prehospital treatment of status epilepticus in the pediatric population. Epilepsia 2015;56(2):254-62. doi: 10.1111/epi. 12905.
10. Silbergleit R, Lowenstein D, Durkalski V, Conwit R; Neurological Emergency Treatment Trials (NETT) Investigators. RAMPART (Rapid Anticonvulsant Medication Prior to Arrival Trial): a double-blind randomized clinical trial of the efficacy of intramuscular midazolam versus intravenous lorazepam in the prehospital treatment of status epilepticus by paramedics. Epilepsia 2011;52 Suppl 8(Suppl 8):45-7. doi: 10.1111/j.1528-1167.2011.03235.x.
11. Momen A, Malamiri R, Nikkhah A, et al. Efficacy and safety of intramuscular midazolam versus rectal diazepam in controlling status epilepticus in children. Eur J Paediatr Neurol 2014:2-7. doi: 10.1016/j.ejpn.2014.11. 007.
12. Ryan PM, Kienstra AJ, Cosgrove P, Vezzetti R, Wilkinson M. Safety and effectiveness of intranasal midazolam and fentanyl used in combination in the pediatric emergency department. Am J Emerg Med. 2019; 37(2):237-240. doi: 10.1016/j.ajem.2018.05.036.
13. Calligaris L, Davide Z, Alessandra M, De Bortoli R, Chiaretti A, Barbi E. Concentrated midazolam for intranasal administration: a pilot study. Pediatr Emerg Care. 2011;27(3): 245-7. doi: 10.1097/PEC.0b013e31820db93b.
14. Klein EJ, Brown JC, Kobayashi A, Osincup D, Seidel K. A randomized clinical trial comparing oral, aerosolized intranasal, and aerosolized buccal midazolam. Ann Emerg Med 2011;58(4):323-9. doi: 10.1016/j.annemergmed.2011.05.016.
15. Lane RD, Schunk JE. Atomized intranasal midazolam use for minor procedures in the pediatric emergency department. Pediatr Emerg Care 2008;24(5):300-3. doi: 10.1097/ PEC.0b013e31816ecb6f.
16. Smith D, Cheek H, Denson B, et al. Lidocaine Pretreatment Reduces the Discomfort of Intranasal Midazolam Administration: A Randomized, Double-blind, Placebo-controlled Trial. Acad Emerg Med 2017;24(2):161-7. doi: 10.1111/acem.13115.
17. Cozzi G, Morabito G, Caddeo G, et al. Dexmedetomidina intranasale per sedazione procedurale. Medico e Bambino 2016;35 (10):641-5.
18. Poonai N, Spohn J, Vandermeer B, et al. Intranasal Dexmedetomidine for Procedural Distress in Children: A Systematic Review. Pediatrics 2020;145(1):e20191623. doi: 10.1542/peds.2019-1623.
19. Cozzi G, Norbedo S, Barbi E. Intranasal Dexmedetomidine for Procedural Sedation in Children, a Suitable Alternative to Chloral Hydrate. Pediatr Drugs 2017;19(2):107-11. doi: 10.1007/s40272-017-0217-5.
20. Mason KP, O’Mahony E, Zurakowski D, Libenson MH. Effects of dexmedetomidine sedation on the EEG in children. Paediatr Anaesth 2009;19(12):1175-1183. doi: 10.1111/ j.1460-9592.2009.03160.x.
21. Cossovel F, Trombetta A, Ramondo A, et al. Intranasal dexmedetomidine and intranasal ketamine association allows shorter induction time for pediatric sedation compared to intranasal dexmedetomidine and oral midazolam. Ital J Pediatr 2022;48(1):1-5. doi: 10.1186/s13052-021-01196-0.
22. Bua J, Massaro M, Cossovel F, et al. Intranasal dexmedetomidine, as midazolam-sparing drug, for MRI in preterm neonates. Paediatr Anaesth.2018;28(8):747-8. doi: 10.1111/pan.13454.
23. Morse JD, Cortinez LI, Anderson BJ. Pharmacokinetic concepts for dexmedetomidine target-controlled infusion pumps in children. Paediatr Anaesth 2021;31(9):924-31. doi: 10.1111/pan.14235.
24. Olgun G, Ali MH. Use of Intranasal Dexmedetomidine as a Solo Sedative for MRI of Infants. Hosp Pediatr 2018;8(2):68-71. doi: 10.1542/hpeds.2017-0120.
25. Mahmoud M, Barbi E, Mason KP. Dexmedetomidine: What’s new for pediatrics? a narrative review. J Clin Med 2020;9(9):1-23. doi: 10.3390/jcm9092724.
26. De Zen L, Della Paolera S, Del Rizzo I, Taucar V, Skabar A, Barbi E. Home Intranasal Dexmedetomidine for Refractory Dystonia in Pediatric Palliative Care. J Pain Symptom Manage 2020;59(6):e3-e5. doi: 10.1016/ j.jpainsymman.2020.02.022.
27. De Zen L, Marchetti F, Barbi E, et al. Cure palliative pediatriche e uso di farmaci off-label. Medico e Bambino 2019;38(2):97-102.
28. Borland M, Jacobs I, King B, O'Brien D. A randomized controlled trial comparing intranasal fentanyl to intravenous morphine for managing acute pain in children in the emergency department. Ann Emerg Med 2007;49 (3):335-40. doi: 10.1016/j.annemergmed. 2006.06.016.
29. Finn M, Harris D. Intranasal fentanyl for analgesia in the paediatric emergency department. Emerg Med J 2010;27(4):300-1. doi: 10.1136/emj.2008.070474.
30. Anderson R, Byrum R, Coates P, Sando G. Mutations at the lysosomal acid cholesteryl ester hydrolase gene locus in Wolman disease. Proc Natl Acad Sci USA 1994;91(7):2718-22. doi: 10.1073/pnas.91.7.2718.
31. Yang F, Liu Y, Yu Q, et al. Analysis of 17 948 pediatric patients undergoing procedural sedation with a combination of intranasal dexmedetomidine and ketamine. Paediatr Anaesth 2019;29(1):85-91. doi: 10.1111/pan.13526.
32. Tsze D, Lubell T, Carter R, et al. Intranasal ketorolac versus intravenous ketorolac for treatment of migraine headaches in children: A randomized clinical trial. Acad Emerg Med 2022;29(4):465-75. doi: 10.1111/acem.14422.
33. Eli Lilly. BAQSIMITM (glucagon) Nasal Powder 3 mg, the First and Only Nasally Administered Glucagon to Treat Severe Hypoglycemia in Adults and Children with Diabetes Ages Four Years and Older, Approved by FDA. Eli Lilly 2019:8-11.
34. Pontiroli AE, Tagliabue E. Therapeutic Use of Intranasal Glucagon: Resolution of Hypoglycemia. Int J Mol Sci 2019;20(15): 3646. doi: 10.3390/ijms20153646.
35. Singh-franco D, Moreau C, Levin AD, et al. Efficacy and Usability of Intranasal Glucagon for the Management of Hypoglycemia in Patients With Diabetes: A Systematic Review. Clin Ther 2022;42(9):e177-e208. doi: 10.1016/j.clinthera.2020.06.024.
36. Sherr JL, Ruedy KJ, Foster NC, et al. Glucagon nasal powder: A promising alternative to intramuscular glucagon in youth with type 1 diabetes. Diabetes Care 2016;39(4):555-62. doi: 10.2337/dc15-1606.
37. Guzman CB, Dulude H, Piché C, et al. Effects of common cold and concomitant administration of nasal decongestant on the pharmacokinetics and pharmacodynamics of nasal glucagon in otherwise healthy participants: A randomized clinical trial. Diabetes, Obes Metab 2018;20(3):646-53. doi: 10.1111/ dom.13134.
38. Settles J, Hinnen D, Spaepen E, et al. Endocrine Practice Nasal Glucagon Is Easier to Use and More Preferred and Needs Less Effort to Administer Than Injectable Glucagon: User Perceptions of Glucagon Administration During Severe Hypoglycemia Simulation. Endocr Pract 2022;28(5):486-93. doi: 10.1016/j.eprac.2022.02.012.
39. Yong J, Anand G. Question 2: Does intranasal sumatriptan use relieve migraine in children and young people? Arch Dis Child 2013;98(1):82-4. doi: 10.1136/archdischild-2012-302879.
40. Menshawy A, Ahmed H, Ismail A, et al. Intranasal sumatriptan for acute migraine attacks: a systematic review and meta-analysis. Neurol Sci 2018;39(1):31-44. doi: 10.1007/ s10072-017-3119-y.
41. Scheepers LD, Montgomery CJ, Kinahan AM, Dunn GS, Bourne RA, McCormack JP. Plasma concentrations of flumazenil following intranasal administration in children. Can J Anaesth 2000;47(2):120-4. doi: 10.1007/BF03018846.
42. Robinson A, Wermeling DP. Intranasal naloxone administration for treatment of opioid overdose. Am J Heal Pharm 2014;71 (24):2129-35. doi: 10.2146/ajhp130798.
43. Heard C, Creighton P, Lerman J. Intranasal flumazenil and naloxone to reverse over-sedation in a child undergoing dental restorations. Paediatr Anaesth 2009;19(8):795-7. doi: 10.1111/j.1460-9592.2009.03069_1.x.
Corrispondenza: giorgio.cozzi@burlo.trieste.it