Intranasal therapy with opioids for children and adolescents with cancer: results from clinical studies
Opioids are essential for the treatment of pain, which is a serious symptom for children and adolescents affected by cancer. Intranasal opioids may be very useful for the treatment of breakthrough pain in children and adolescents with cancer, for their little invasiveness, ease of administration, rapid onset of action, and high bioavailability. Intranasal drug delivery may be influenced by anatomical and physiological factors (nasal mucosa absorption area, mucociliary clearance, enzymatic activity, anatomical anomalies, chronic or inflammatory alterations of nasal mucosa), drug-related factors (molecular weight, solubility), and delivery device. Fentanyl is a lipophilic opioid commonly proposed for intranasal use among pediatric patients, but no studies have been conducted yet about intranasal use of other available opioids for management of pediatric cancer pain. In this review, we analyze several elements which may influence absorption of intranasal opioids in children and adolescents, with a focus on pharmacokinetics and therapeutic aspects of each opioid currently available for intranasal use.
KeywordsIntranasal Opioids Cancer pain Pediatric patients Fentanyl
This work was supported by Fondazione per l’Oncologia Pediatrica.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.Del Pizzo J, Callahan JM (2014) Intranasal medications in pediatric emergency medicine. Pediatr Emerg Care 30(7):496–501; quiz 502–4. https://doi.org/10.1097/PEC.0000000000000171
- 7.Newman SP, Morén F, Clarke SW (1987) Deposition pattern from a nasal pump spray. Rhinology 25(2):77–82Google Scholar
- 14.Pandey RK, Bahetwar SK, Saksena AK, Chandra G (2011) A comparative evaluation of drops versus atomized administration of intranasal ketamine for the procedural sedation of young uncooperative pediatric dental patients: a prospective crossover trial. J Clin Pediatr Dent Fall 36(1):79–84CrossRefGoogle Scholar
- 27.Kress HG, Oronska A, Kaczmarek Z et al (2009) Efficacy and tolerability of intranasal fentanyl spray 50 to 200 microg for breakthrough pain in patients with cancer: a phase III, multinational, randomized, doubleblind, placebo-controlled, crossover trial with a 10-month, open-label extension treatment period. Clin Ther 31:1177–1191CrossRefGoogle Scholar
- 28.Christrup LL, Foster D, Popper L, Troen T, Upton R (2008) Pharmacokinetics, efficacy, and tolerability of fentanyl following intranasal versus intravenous administration in adults undergoing third-molar extraction: a randomized, double-blind, double-dummy, two-way, cross-over study. Clin Ther 30:469–481CrossRefGoogle Scholar
- 31.Nave R, Sides EH, Colberg T et al. (2009) Pharmacokinetics of intranasal fentanyl spray (INFS) in subjects with common cold. 6th congress of the European federation of IASP chapters, LisbonGoogle Scholar
- 41.Dowling J, Isbister GK, Kirkpatrick CM, Naidoo D, Graudins A (2008) Population pharmacokinetics of intravenous, intramuscular, and intranasal naloxone in human volunteers. Ther Drug Monit 30:490–496Google Scholar