Importancia de la vía nasal para la administración de opioides

Abstract

Intranasal (IN) opioid administration is a highly effective alternative to other routes of administration due to the exceptional conditions of the nasal mucosa for opioid absorption. This route is ideal for fentanyl administration for the treatment of breakthrough cancer pain, which requires an analgesic that is potent, with rapid onset, short duration, easy administration and few adverse effects. Among transmucosal fentanyl preparations, the best adapted to breakthrough cancer pain are IN preparations. These rapid and effective preparations are available in aqueous solution and in pectin. They are not interchangeable and can only be substituted after a new titration. Fentanyl pectin nasal spray has a reliable profile of action against eventual losses due to postnasal drip or mucociliary clearance. The preparation is simply and easy to administer with rapid onset and is not affected by the dry mouth that is common in advanced cancer patients, or possible oral mucositis or rhinitis. Administration does not depend on the patient's skill. This drug has no relevant systemic or local adverse effects. Onset of analgesia occurs 5minutes after application and the drug is well tolerated and accepted by patients. Dose adjustments are not normally required after titration, even in the long-term. This review describes the characteristics of the IN route, together with the use of distinct opioids, with particular emphasis on fentanyl pectin nasal spray.